Provider Demographics
NPI:1639201072
Name:BUTLER, PEGGY D (MS, MFT, RC)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:D
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MS, MFT, RC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15100 176TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-6331
Mailing Address - Country:US
Mailing Address - Phone:425-483-5344
Mailing Address - Fax:
Practice Address - Street 1:220 S 3RD PL
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-2405
Practice Address - Country:US
Practice Address - Phone:425-228-0074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8942504OtherCRIME VICTIM COMPENSATION