Provider Demographics
NPI:1699953885
Name:BUTLER, KELLY LYNN (MA, LCPC, LADC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MA, LCPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3638
Mailing Address - Country:US
Mailing Address - Phone:207-871-7431
Mailing Address - Fax:
Practice Address - Street 1:307 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3638
Practice Address - Country:US
Practice Address - Phone:207-871-7431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-10
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)