Provider Demographics
NPI:1578975512
Name:BUTLER, LATINA
Entity type:Individual
Prefix:MS
First Name:LATINA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 181371
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32318-0041
Mailing Address - Country:US
Mailing Address - Phone:850-320-8379
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 181371
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32318-0041
Practice Address - Country:US
Practice Address - Phone:850-320-8379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-26
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20523101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health