Provider Demographics
NPI:1164702841
Name:BUTCHER, WALTER JAMES (MFT)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:JAMES
Last Name:BUTCHER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:BUTCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:8117 W MANCHESTER AVE
Mailing Address - Street 2:#175
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8745
Mailing Address - Country:US
Mailing Address - Phone:310-283-1486
Mailing Address - Fax:
Practice Address - Street 1:8505 SARAN DR
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-8413
Practice Address - Country:US
Practice Address - Phone:310-283-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47926101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health