Provider Demographics
NPI:1053628792
Name:BUTLER, ELIZABETH FOX (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:FOX
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:FB
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4713 1ST ST
Mailing Address - Street 2:STE 254
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7361
Mailing Address - Country:US
Mailing Address - Phone:925-421-6868
Mailing Address - Fax:
Practice Address - Street 1:4713 1ST ST
Practice Address - Street 2:STE 254
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7361
Practice Address - Country:US
Practice Address - Phone:925-421-6868
Practice Address - Fax:925-462-0545
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94020676103T00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist