Provider Demographics
NPI:1982236634
Name:BUTCHER-HOUSTON, CARMEN LYNN (LSWAIC)
Entity type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:LYNN
Last Name:BUTCHER-HOUSTON
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SE 184TH AVE # C32
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-1928
Mailing Address - Country:US
Mailing Address - Phone:503-890-4656
Mailing Address - Fax:
Practice Address - Street 1:1601 E FOURTH PLAIN BLVD # A152
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3713
Practice Address - Country:US
Practice Address - Phone:360-397-8198
Practice Address - Fax:360-397-8276
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC609476501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1079492Medicaid