Individual
MISS KIMBERLY LYLES BUTTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
545 ESTUDILLO AVE, SAN LEANDRO, CA 94577-4611
(510) 352-9200
Mailing address
1065 A ST, HAYWARD, CA 94541-4148
(510) 459-5294
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
172V00000X
Community Health Worker
MPSS-MKHLRT
CA
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B9627718
CALIFORNIA ID
CA
Enumeration date
07/17/2018
Last updated
02/07/2025
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