Individual
JEFFERSON BUTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1210 SW 136TH STREET, BURIEN, WA 98166
(206) 257-6759
Mailing address
1210 SW 136TH STREET, BURIEN, WA 98166
(206) 257-6759
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5120074-01
—
WA
Enumeration date
09/27/2018
Last updated
09/27/2018
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