Provider Demographics
NPI:1609457175
Name:BUTLER, CLIFFORD JACK II
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:JACK
Last Name:BUTLER
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 SW 105TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5488
Mailing Address - Country:US
Mailing Address - Phone:971-200-1966
Mailing Address - Fax:971-754-4141
Practice Address - Street 1:6800 SW 105TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-5488
Practice Address - Country:US
Practice Address - Phone:971-200-1966
Practice Address - Fax:971-754-4141
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor