Provider Demographics
NPI:1669575759
Name:BUTCHER, NICK T (MA, LCPC)
Entity type:Individual
Prefix:
First Name:NICK
Middle Name:T
Last Name:BUTCHER
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W 89TH ST
Mailing Address - Street 2:SUITE 3001
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1946
Mailing Address - Country:US
Mailing Address - Phone:913-982-8204
Mailing Address - Fax:816-554-4370
Practice Address - Street 1:2020 W 89TH ST
Practice Address - Street 2:SUITE 3001
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-1946
Practice Address - Country:US
Practice Address - Phone:913-982-8204
Practice Address - Fax:816-554-4370
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999142227101YP2500X
KS773101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional