MEDICARE: CHRISTIAN BUTLER

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
1	106H00000X	Marriage & Family Therapist	106069	CA

General Provider Information

NPI Number	:	1073911848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN BUTLER

Provider Business Mailing Address
First Line	:	780 E GILBERT ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92415-1003
Country	:	US
Telephone Number	:	909-763-4760
Fax Number	:

Provider Business Practice Location Address
First Line	:	4029 WESTERLY PL STE 101
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2329
Country	:	US
Telephone Number	:	714-492-4937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2014
Last Update Date	:	01/03/2023

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