Healthcare Provider Details

I. General information

NPI: 1427217819
Provider Name (Legal Business Name): SYREETA PATRICE BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15317 RAYEN ST
NORTH HILLS CA
91343-5117
US

IV. Provider business mailing address

1420 S ORANGE GROVE AVE APT 9
LOS ANGELES CA
90019-3739
US

V. Phone/Fax

Practice location:
  • Phone: 818-916-3999
  • Fax:
Mailing address:
  • Phone: 818-288-3062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT-INTERN 63873
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: