Provider Demographics
NPI:1336557172
Name:BUTLER, GREGORY STUART (PSYCHOLOGY BA)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:STUART
Last Name:BUTLER
Suffix:
Gender:M
Credentials:PSYCHOLOGY BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6623 1/2 GAVIOTA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE BALBOA
Mailing Address - State:CA
Mailing Address - Zip Code:91406-5942
Mailing Address - Country:US
Mailing Address - Phone:213-915-2249
Mailing Address - Fax:
Practice Address - Street 1:566 S BRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4002
Practice Address - Country:US
Practice Address - Phone:818-898-0223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program