MEDICARE: KRISTIN VENDORA BUTLER I

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	AMFT122870	CA

General Provider Information

NPI Number	:	1851852396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN VENDORA BUTLER I

Provider Business Mailing Address
First Line	:	11100 SAN PABLO AVE STE 205
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-2100
Country	:	US
Telephone Number	:	510-525-6225
Fax Number	:

Provider Business Practice Location Address
First Line	:	11100 SAN PABLO AVE STE 205
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-2100
Country	:	US
Telephone Number	:	510-525-6225
Fax Number	:

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

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	09/07/2023

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