Provider Demographics
NPI:1588397459
Name:BUTTNER, GREGORY IAN (LMFT 138273)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:IAN
Last Name:BUTTNER
Suffix:
Gender:M
Credentials:LMFT 138273
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4995 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-3795
Mailing Address - Country:US
Mailing Address - Phone:760-498-8859
Mailing Address - Fax:
Practice Address - Street 1:4995 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-3795
Practice Address - Country:US
Practice Address - Phone:760-498-8859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138273106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist