Provider Demographics
NPI:1538769393
Name:BUTSON, DARRYL WILLIAM (LMFT)
Entity type:Individual
Prefix:
First Name:DARRYL
Middle Name:WILLIAM
Last Name:BUTSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1826
Mailing Address - Country:US
Mailing Address - Phone:619-996-3195
Mailing Address - Fax:619-996-3196
Practice Address - Street 1:549 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1826
Practice Address - Country:US
Practice Address - Phone:619-996-3195
Practice Address - Fax:619-996-3196
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121108106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty