Provider Demographics
NPI:1689160012
Name:BUTLER, KATHERINE ELLEN (AMFT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELLEN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:689 FOREST WAY
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3974
Mailing Address - Country:US
Mailing Address - Phone:415-578-8367
Mailing Address - Fax:
Practice Address - Street 1:3434 MENDOCINO AVE # A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2274
Practice Address - Country:US
Practice Address - Phone:707-284-1978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF82150101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health