Healthcare Provider Details

I. General information

NPI: 1508561127
Provider Name (Legal Business Name): JESSICA BUTLER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4281 PIEDMONT AVE
OAKLAND CA
94611-4713
US

IV. Provider business mailing address

PO BOX 11056
OAKLAND CA
94611-0056
US

V. Phone/Fax

Practice location:
  • Phone: 510-394-2129
  • Fax:
Mailing address:
  • Phone: 510-394-2129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number151334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: