Active NPI
Antwan Raheem Butler, LCSW-BACS
- Clinical Social Worker
- Shreveport, LA
National Provider Identifier
1528461480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 9084
- Practice address
- 6808 Jefferson Paige Rd
Shreveport, LA 71119-3302 - Phone
- (318) 564-2208
- Fax
- (318) 525-9007
- NPI assigned
- Oct 6, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 9084 | LA | Primary |
Addresses
Primary practice location
6808 Jefferson Paige Rd
Shreveport, LA 71119-3302
Mailing address
6808 Jefferson Paige Road
Shreveport, LA 71119
Phone (318) 564-2208
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9084 | LA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Restoration Crisis Center Therapeutic Home | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Emotionally Disturbed Childrens' Residential Treatment Facility
- Shreveport, LA
- NPI 1558857888
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412553600000",
"number": "1528461480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6808 JEFFERSON PAIGE ROAD",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "71119",
"telephone_number": "318-564-2208",
"fax_number": "318-525-9007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6808 JEFFERSON PAIGE RD",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711193302",
"telephone_number": "318-564-2208",
"fax_number": "318-525-9007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUTLER",
"first_name": "ANTWAN",
"middle_name": "RAHEEM",
"name_prefix": "Mr.",
"credential": "LCSW-BACS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-10-06",
"last_updated": "2014-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "LA",
"license": "9084",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.