Provider Demographics
NPI:1386946861
Name:BUTCHER, LEXEE (IADC)
Entity type:Individual
Prefix:
First Name:LEXEE
Middle Name:
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:IADC
Other - Prefix:
Other - First Name:LEXEE
Other - Middle Name:
Other - Last Name:GALLOWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2190 NW 82ND ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-5510
Mailing Address - Country:US
Mailing Address - Phone:515-635-5341
Mailing Address - Fax:
Practice Address - Street 1:2190 NW 82ND ST STE 1
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-5510
Practice Address - Country:US
Practice Address - Phone:515-635-5341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA10126101YA0400X
IA001459101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1386946861Medicaid