Provider Demographics
NPI:1659805042
Name:INGRID YOGITA BUTLER
Entity Type:Organization
Organization Name:INGRID YOGITA BUTLER
Other - Org Name:5 ELEMENTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:YOGITA
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:505-414-7620
Mailing Address - Street 1:PO BOX 20246
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87154-0246
Mailing Address - Country:US
Mailing Address - Phone:505-414-7620
Mailing Address - Fax:
Practice Address - Street 1:11930 MENAUL BLVD NE
Practice Address - Street 2:SUITE 106A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2478
Practice Address - Country:US
Practice Address - Phone:505-414-7620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5899174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM5899OtherLICENSED MASSAGE THERAPIST