Healthcare Provider Details

I. General information

NPI: 1265572002
Provider Name (Legal Business Name): CARLEY BUTLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 RUSTIN AVE MAIL STOP #3804
RIVERSIDE CA
92507-2498
US

IV. Provider business mailing address

PO BOX 7549
RIVERSIDE CA
92513-7549
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-7797
  • Fax:
Mailing address:
  • Phone:
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number61483
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: