Provider Demographics
NPI:1679889919
Name:BUTCHER, MARK ALAN (LPC, LMHC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:BUTCHER
Suffix:
Gender:M
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 S. 38TH ST
Mailing Address - Street 2:#193
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409
Mailing Address - Country:US
Mailing Address - Phone:253-287-5367
Mailing Address - Fax:
Practice Address - Street 1:2602 S 38TH ST UNIT 193
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-6665
Practice Address - Country:US
Practice Address - Phone:253-287-5367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60697728101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC006054OtherGEORGIA LICENSE