Provider Demographics
NPI:1710249180
Name:BUTLER, SHANNA ELISE (MSW)
Entity Type:Individual
Prefix:MS
First Name:SHANNA
Middle Name:ELISE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 TELEGRAPH AVE.
Mailing Address - Street 2:PACIFIC CENTER FOR HUMAN GROWTH
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94602
Mailing Address - Country:US
Mailing Address - Phone:510-548-8283
Mailing Address - Fax:
Practice Address - Street 1:2712 TELEGRAPH AVE.
Practice Address - Street 2:PACIFIC CENTER FOR HUMAN GROWTH
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94602
Practice Address - Country:US
Practice Address - Phone:510-548-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist