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General NPI Number Information
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NPI Number | 1073099552
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Entity Type | Individual
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Provider Name | MISS KIMBERLY LYLES BUTTS
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Gender | Female
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 545 ESTUDILLO AVE
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City | SAN LEANDRO
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State | CA
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Zip | 94577-4611
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Country | US
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Telephone | 510-352-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 1065 A ST
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City | HAYWARD
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State | CA
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Zip | 94541-4148
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Country | US
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Telephone | 510-459-5294
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | MPSS-MKHLRT
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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