Provider Demographics
NPI:1255576336
Name:HASTARAN, BUTCH JOHN JR
Entity type:Individual
Prefix:
First Name:BUTCH
Middle Name:JOHN
Last Name:HASTARAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 PORTAL DR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-1230
Mailing Address - Country:US
Mailing Address - Phone:530-894-6248
Mailing Address - Fax:
Practice Address - Street 1:109 PARMAC RD
Practice Address - Street 2:#1
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2218
Practice Address - Country:US
Practice Address - Phone:530-891-2981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor