Individual
BLAKE BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1513 LINE AVENUE, SUITE 225, SHREVEPORT, LA 71101
(318) 754-3890
Mailing address
1513 LINE AVENUE, SUITE 225, SHREVEPORT, LA 71101
(318) 754-3890
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/09/2019
Last updated
03/09/2019
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