Healthcare Provider Details

I. General information

NPI: 1376263178
Provider Name (Legal Business Name): J BUTLER PMHNP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 08/31/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 STATE STREET STE 4
HOOD RIVER OR
97031
US

IV. Provider business mailing address

2873 MAY ST
HOOD RIVER OR
97031-9788
US

V. Phone/Fax

Practice location:
  • Phone: 9
  • Fax:
Mailing address:
  • Phone: 503-957-2193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JODIE BUTLER
Title or Position: PMHNP
Credential: NP
Phone: 971-299-1275