Provider Demographics
NPI:1932340577
Name:BUTCHER, LINDA SUSAN (MA, LMFT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SUSAN
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 N FULTON ST
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-3128
Mailing Address - Country:US
Mailing Address - Phone:979-282-8100
Mailing Address - Fax:979-282-8103
Practice Address - Street 1:1114 N FULTON ST
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-3128
Practice Address - Country:US
Practice Address - Phone:979-282-8100
Practice Address - Fax:979-282-8103
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200938106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200672802Medicaid