Provider Demographics
NPI:1871318352
Name:BUTLER, SHANTEL MURICE (LAPC)
Entity type:Individual
Prefix:
First Name:SHANTEL
Middle Name:MURICE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 EVERGREEN TRL
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-8365
Mailing Address - Country:US
Mailing Address - Phone:912-844-0360
Mailing Address - Fax:
Practice Address - Street 1:1221 EVERGREEN TRL
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-8365
Practice Address - Country:US
Practice Address - Phone:912-844-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAACP009604101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty