Provider Demographics
NPI:1366786832
Name:BUTLER, TIFFANY JO (LPC)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:JO
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-6329
Mailing Address - Country:US
Mailing Address - Phone:605-336-2556
Mailing Address - Fax:605-339-3345
Practice Address - Street 1:310 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-6329
Practice Address - Country:US
Practice Address - Phone:605-336-2556
Practice Address - Fax:605-339-3345
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC7234101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional