1184697575 NPI number — MR. RONALD WILLIAM BUTCHER LCSW

Table of content: MR. RONALD WILLIAM BUTCHER LCSW (NPI 1184697575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184697575 NPI number — MR. RONALD WILLIAM BUTCHER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTCHER
Provider First Name:
RONALD
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUTCHER
Provider Other First Name:
RON
Provider Other Middle Name:
WILLIAM
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1184697575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2020 WEST PINHOOK ROAD
Provider Second Line Business Mailing Address:
SUITE 504
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-593-0830
Provider Business Mailing Address Fax Number:
337-593-0122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 WEST PINHOOK ROAD
Provider Second Line Business Practice Location Address:
SUITE 504
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-593-0830
Provider Business Practice Location Address Fax Number:
337-593-0122
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  1823 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 1823 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5849 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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