Provider Demographics
NPI:1336384163
Name:EBANKS-BUTLER, SHANA (LMFT)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:EBANKS-BUTLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:L
Other - Last Name:EBANKS-BUTLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SHANA BUTLER
Mailing Address - Street 1:2464 SLEW OF GOLD CT
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-2546
Mailing Address - Country:US
Mailing Address - Phone:951-442-1633
Mailing Address - Fax:
Practice Address - Street 1:600 N ARROWHEAD AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1164
Practice Address - Country:US
Practice Address - Phone:909-963-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102284106H00000X, 106H00000X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner