Provider Demographics
NPI:1962620526
Name:BUTTERLY, MARY CATHERINE (MFT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:BUTTERLY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4959 PALO VERDE ST
Mailing Address - Street 2:SUITE 206C-2
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2331
Mailing Address - Country:US
Mailing Address - Phone:909-626-9401
Mailing Address - Fax:909-626-9382
Practice Address - Street 1:4959 PALO VERDE ST
Practice Address - Street 2:SUITE 206C-2
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2331
Practice Address - Country:US
Practice Address - Phone:909-626-9401
Practice Address - Fax:909-626-9382
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41930106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist