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General NPI Number Information
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NPI Number | 1356755581
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Entity Type | Individual
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Provider Name | RYAN BUTLER
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Gender | Male
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Dates
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Enumeration Date | 06/16/2014
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 1675 NORTHCREST DR
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City | CRESCENT CITY
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State | CA
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Zip | 95531-8928
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Country | US
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Telephone | 707-464-2750
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 WEEOT WAY
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City | ARCATA
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State | CA
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Zip | 95521-4734
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Country | US
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Telephone | 707-825-5000
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5868004-3501
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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