MEDICARE: LISA BUTTON SUDCC 8711

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	8711	CA

General Provider Information

NPI Number	:	1346715091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BUTTON SUDCC 8711

Provider Business Mailing Address
First Line	:	29833 SANTA MARGARITA PKWY STE 400
Second Line	:
City	:	RANCHO SANTA MARGARITA
State	:	CA
Zip	:	92688-3619
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	29833 SANTA MARGARITA PKWY STE 400
Second Line	:
City	:	RANCHO SANTA MARGARITA
State	:	CA
Zip	:	92688-3619
Country	:	US
Telephone Number	:	949-283-1260
Fax Number	:

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

Provider Enumeration Date	:	10/09/2018
Last Update Date	:	08/16/2022

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