Provider Demographics
NPI:1437583317
Name:BUTORAC, TERRIE LEILA (MFT)
Entity Type:Individual
Prefix:
First Name:TERRIE
Middle Name:LEILA
Last Name:BUTORAC
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24751 VIA SAN FERNANDO
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-2431
Mailing Address - Country:US
Mailing Address - Phone:949-525-2374
Mailing Address - Fax:
Practice Address - Street 1:24800 CHRISANTA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4833
Practice Address - Country:US
Practice Address - Phone:949-525-2374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34910106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist