MEDICARE: HALEIGH J BUTLER LPCC

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	101YP2500X	Professional Counselor	6540	CA

General Provider Information

NPI Number	:	1760031686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEIGH J BUTLER LPCC

Provider Business Mailing Address
First Line	:	4701 COLFAX AVE UNIT 6
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-1067
Country	:	US
Telephone Number	:	440-666-1491
Fax Number	:

Provider Business Practice Location Address
First Line	:	4370 TUJUNGA AVE STE 110
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-2753
Country	:	US
Telephone Number	:	303-335-0996
Fax Number	:

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

Provider Enumeration Date	:	09/04/2019
Last Update Date	:	02/09/2024

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