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General NPI Number Information
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NPI Number | 1548848070
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Entity Type | Individual
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Provider Name | MELISSA JEAN BUTLER
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Gender | Female
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 1023 N HOLLYWOOD WAY STE 4B
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City | BURBANK
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State | CA
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Zip | 91505-2539
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Country | US
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Telephone | 424-835-5584
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Fax |
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Provider Business Mailing Address
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Address Line | 3821 MENTONE AVE APT 102
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City | CULVER CITY
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State | CA
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Zip | 90232-3375
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Country | US
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Telephone | 908-489-6663
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 147353
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License Number State | CA
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