Healthcare Provider Details

I. General information

NPI: 1902127681
Provider Name (Legal Business Name): TYRA MARIE BUTLER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 HUSHABYE LN
CORONA CA
92878-3713
US

IV. Provider business mailing address

1075 HUSHABYE LN
CORONA CA
92878-3713
US

V. Phone/Fax

Practice location:
  • Phone: 949-292-2923
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number84309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: