Provider Demographics
NPI:1770982902
Name:BUTLER, KIMBERLY ROME (LPC, NCC, MS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ROME
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LPC, NCC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4147 COPERNICUS ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-3415
Mailing Address - Country:US
Mailing Address - Phone:504-292-9291
Mailing Address - Fax:
Practice Address - Street 1:2372 SAINT CLAUDE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-8351
Practice Address - Country:US
Practice Address - Phone:504-292-9291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4913101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional