Provider Demographics
NPI:1649071283
Name:BUTLER, KATHY K (PSYCH TECH)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:K
Last Name:BUTLER
Suffix:
Gender:
Credentials:PSYCH TECH
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WELLS
Mailing Address - Street 1:19805 SHAKE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:VOLCANO
Mailing Address - State:CA
Mailing Address - Zip Code:95689-9719
Mailing Address - Country:US
Mailing Address - Phone:805-769-0301
Mailing Address - Fax:
Practice Address - Street 1:19805 SHAKE RIDGE RD
Practice Address - Street 2:
Practice Address - City:VOLCANO
Practice Address - State:CA
Practice Address - Zip Code:95689-9719
Practice Address - Country:US
Practice Address - Phone:805-769-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36701167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician