Healthcare Provider Details

I. General information

NPI: 1417207481
Provider Name (Legal Business Name): MRS. ELIZABETH M BEUTTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH M VAN NOTE

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HOSPITAL RD
SONORA CA
95370-4618
US

IV. Provider business mailing address

2 S. GREEN ST.
SONORA CA
95370-4618
US

V. Phone/Fax

Practice location:
  • Phone: 209-533-6245
  • Fax: 209-533-7007
Mailing address:
  • Phone: 209-533-6245
  • Fax: 209-533-7007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number110431
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number110431
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: