Provider Demographics
NPI:1770780595
Name:BUETHE, SHANTELLE NOEL (MA)
Entity type:Individual
Prefix:MRS
First Name:SHANTELLE
Middle Name:NOEL
Last Name:BUETHE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 ALPHA RD
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-5505
Mailing Address - Country:US
Mailing Address - Phone:209-668-4651
Mailing Address - Fax:209-668-4666
Practice Address - Street 1:743 ALPHA RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-5505
Practice Address - Country:US
Practice Address - Phone:209-668-4651
Practice Address - Fax:209-668-4666
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF#52721106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist