Provider Demographics
NPI:1962877464
Name:BUTTS, HEATHER (LCSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BUTTS
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 BATTLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KOOSKIA
Mailing Address - State:ID
Mailing Address - Zip Code:83539-5092
Mailing Address - Country:US
Mailing Address - Phone:208-553-8137
Mailing Address - Fax:208-298-3851
Practice Address - Street 1:1585 BATTLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:KOOSKIA
Practice Address - State:ID
Practice Address - Zip Code:83539-5092
Practice Address - Country:US
Practice Address - Phone:208-553-8137
Practice Address - Fax:208-298-3851
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-394931041C0700X
MTBBH-LCSW-LIC-706701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical