Provider Demographics
NPI:1679661532
Name:BUTCHER, SANDRA JO (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JO
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43020 ED HALLEY PL
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-4817
Mailing Address - Country:US
Mailing Address - Phone:661-945-1682
Mailing Address - Fax:661-945-6053
Practice Address - Street 1:44426 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3325
Practice Address - Country:US
Practice Address - Phone:661-945-1682
Practice Address - Fax:661-945-6053
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 33412106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist