Provider Demographics
NPI:1073348173
Name:BUTRICK, BRITTNEY ALISE (RADT)
Entity type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:ALISE
Last Name:BUTRICK
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11646 ENCANTO LN
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-9218
Mailing Address - Country:US
Mailing Address - Phone:909-222-4073
Mailing Address - Fax:
Practice Address - Street 1:1026 EDGAR AVE APT A
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-1800
Practice Address - Country:US
Practice Address - Phone:909-222-4073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1553280324101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)