Healthcare Provider Details

I. General information

NPI: 1528508272
Provider Name (Legal Business Name): ADRIANA J BUTLER LCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 04/19/2021
Certification Date: 02/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 E CAMELBACK RD STE 600
PHOENIX AZ
85016-3493
US

IV. Provider business mailing address

2375 E CAMELBACK RD STE 600
PHOENIX AZ
85016-3493
US

V. Phone/Fax

Practice location:
  • Phone: 602-387-5313
  • Fax:
Mailing address:
  • Phone: 602-387-5313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC19535
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-19535
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberLAC - 15768
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: