MEDICARE: CATHERINE M BUTLER MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC39893	CA

General Provider Information

NPI Number	:	1164502951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE M BUTLER MFT

Provider Business Mailing Address
First Line	:	PO BOX 1177
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91944-1177
Country	:	US
Telephone Number	:	619-644-1788
Fax Number	:	619-713-2506

Provider Business Practice Location Address
First Line	:	4582 PALM AVE
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-5549
Country	:	US
Telephone Number	:	619-644-1788
Fax Number	:	619-713-2506

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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