Provider Demographics
NPI:1639823008
Name:BUTLER, RACHAEL (MC61262618)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MC61262618
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 CASCADE PL W APT 2
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-5302
Mailing Address - Country:US
Mailing Address - Phone:253-232-7760
Mailing Address - Fax:
Practice Address - Street 1:2403 CASCADE PL W APT 2
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-5302
Practice Address - Country:US
Practice Address - Phone:253-232-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61262618101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health