Provider Demographics
NPI:1700136694
Name:BUTTKUS, PATRICIA KENDRICK (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:KENDRICK
Last Name:BUTTKUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17451 BASTANCHURY RD
Mailing Address - Street 2:STE. 204-35
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-1857
Mailing Address - Country:US
Mailing Address - Phone:714-974-1621
Mailing Address - Fax:714-485-2316
Practice Address - Street 1:17451 BASTANCHURY RD
Practice Address - Street 2:STE. 204-35
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-1857
Practice Address - Country:US
Practice Address - Phone:714-974-1621
Practice Address - Fax:714-485-2316
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS15889172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker