Provider Demographics
NPI:1326818980
Name:BUTLER, JANET BISHOP (SUDRC 13612)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:BISHOP
Last Name:BUTLER
Suffix:
Gender:F
Credentials:SUDRC 13612
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10087 TERRA LOMA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-3202
Mailing Address - Country:US
Mailing Address - Phone:916-400-4369
Mailing Address - Fax:
Practice Address - Street 1:10087 TERRA LOMA DR
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-3202
Practice Address - Country:US
Practice Address - Phone:916-400-4369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13612101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)