Provider Demographics
NPI:1275612137
Name:BUTLER, JUEREATA L (IMFT)
Entity Type:Individual
Prefix:MRS
First Name:JUEREATA
Middle Name:L
Last Name:BUTLER
Suffix:
Gender:F
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 PARADISE VLY N
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-5649
Mailing Address - Country:US
Mailing Address - Phone:310-518-9330
Mailing Address - Fax:
Practice Address - Street 1:1500 S MCDONNELL AVE
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-5623
Practice Address - Country:US
Practice Address - Phone:323-981-4301
Practice Address - Fax:323-881-6733
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 43978106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist