Provider Demographics
NPI:1861885824
Name:BUTLER, MINDY (LCPC, LADC)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LCPC, LADC
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 61
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009
Mailing Address - Country:US
Mailing Address - Phone:207-595-5159
Mailing Address - Fax:207-803-8664
Practice Address - Street 1:82 MAIN STREET 5B
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009
Practice Address - Country:US
Practice Address - Phone:207-595-5159
Practice Address - Fax:207-333-3037
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4553101YP2500X
MECAC5752101YA0400X
MELC6339101YA0400X
MECC5056101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEXL4553OtherLICENSED CLINICAL PROFESSIONAL COUNSELOR CONDITIONAL