Provider Demographics
NPI:1083737415
Name:BUTTERWORTH, JANE R (LMFT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:R
Last Name:BUTTERWORTH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 COTTONWOOD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:LA LUZ
Mailing Address - State:NM
Mailing Address - Zip Code:88337-9333
Mailing Address - Country:US
Mailing Address - Phone:575-921-8453
Mailing Address - Fax:888-505-1701
Practice Address - Street 1:1200 WHITE SANDS BLVD
Practice Address - Street 2:115
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6774
Practice Address - Country:US
Practice Address - Phone:575-921-8453
Practice Address - Fax:888-505-1701
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0114721106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist