Healthcare Provider Details

I. General information

NPI: 1245161926
Provider Name (Legal Business Name): STACIA M MCANALLY-BUTLER CI50190126
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 AUBURN RAVINE RD
AUBURN CA
95603-3930
US

IV. Provider business mailing address

610 AUBURN RAVINE RD
AUBURN CA
95603-3930
US

V. Phone/Fax

Practice location:
  • Phone: 530-888-8767
  • Fax:
Mailing address:
  • Phone: 530-888-8767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI50190126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: