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NPI Code Detail

MEDICARE: MARISSA NICOLE BUTCHER

MEDICARE: MARISSA NICOLE BUTCHER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistAMFT146576CA
2103K00000XBehavior Analyst1-14 -17496CA

General Provider Information

NPI Number : 1023400694
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISSA NICOLE BUTCHER
Provider Business Mailing Address
First Line : 20 W LUGONIA AVE
Second Line :
City : REDLANDS
State : CA
Zip : 92374-2234
Country : US
Telephone Number : 909-307-5300
Fax Number :
Provider Business Practice Location Address
First Line : 20 W LUGONIA AVE
Second Line :
City : REDLANDS
State : CA
Zip : 92374-2234
Country : US
Telephone Number : 909-936-8090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2015
Last Update Date : 06/04/2024

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Directions to “ MARISSA NICOLE BUTCHER ” Practice Location

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