Provider Demographics
NPI:1346715091
Name:BUTTON, LISA (SUDCC 8711)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BUTTON
Suffix:
Gender:F
Credentials:SUDCC 8711
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:29833 SANTA MARGARITA PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3619
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29833 SANTA MARGARITA PKWY STE 400
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3619
Practice Address - Country:US
Practice Address - Phone:949-283-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8711101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)