Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 19723 | TX |
NPI | 1003000506 |
---|---|
Provider Name | Keisha L. Butler |
First Address | Dallas, TX 75201-4312 |
Second Address | Dallas, TX 75201-4312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 28/08/2007 |