Provider Demographics
NPI:1306362447
Name:BUTLER, ALICE PAULINE (MA)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:PAULINE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:PAULINE
Other - Last Name:LUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:306 WELLS AVE S UNIT D
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2786
Mailing Address - Country:US
Mailing Address - Phone:206-479-4545
Mailing Address - Fax:
Practice Address - Street 1:306 WELLS AVE S UNIT D
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2786
Practice Address - Country:US
Practice Address - Phone:206-479-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY248460101YM0800X
WAMG60875270101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health