Healthcare Provider Details

I. General information

NPI: 1255265328
Provider Name (Legal Business Name): ASHLEY NIKOLE BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2372 MORSE AVE STE 583
IRVINE CA
92614-6234
US

IV. Provider business mailing address

546 PALOS SECOS
ARROYO GRANDE CA
93420-1966
US

V. Phone/Fax

Practice location:
  • Phone: 800-689-8675
  • Fax:
Mailing address:
  • Phone: 805-904-4611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: