MEDICARE: MELISSA JEAN BUTLER

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	225400000X	Rehabilitation Practitioner
2	106H00000X	Marriage & Family Therapist	147353	CA

General Provider Information

NPI Number	:	1548848070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA JEAN BUTLER

Provider Business Mailing Address
First Line	:	3821 MENTONE AVE APT 102
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90232-3375
Country	:	US
Telephone Number	:	908-489-6663
Fax Number	:

Provider Business Practice Location Address
First Line	:	1023 N HOLLYWOOD WAY STE 4B
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-2539
Country	:	US
Telephone Number	:	424-835-5584
Fax Number	:

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

Provider Enumeration Date	:	03/29/2021
Last Update Date	:	10/29/2024

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Directions to “ MELISSA JEAN BUTLER ” Practice Location

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