Provider Demographics
NPI:1245360999
Name:BUTLER, KELLEY (LCSW)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3579 E. FOOTHILL BOULEVARD
Mailing Address - Street 2:#237
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107
Mailing Address - Country:US
Mailing Address - Phone:310-497-8274
Mailing Address - Fax:
Practice Address - Street 1:3579 E FOOTHILL BLVD
Practice Address - Street 2:#237
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3119
Practice Address - Country:US
Practice Address - Phone:310-497-8274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS196971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical