| Doctor Name: | MRS. JACQUELINE LEE BUTERA |
| NPI Number: | 1033325543 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LPC |
| License Number: | LPC3268 |
| Business Practice Address: | 1200 W Ironwood Dr Suite 101 Coeur D Alene, ID - 838142660 |
| Business Phone Number: | 2086649729 |
| Business Fax Number: | 2082637515 |
| Mailing Address: | 5486 N Martha Loop, COEUR D ALENE |
| State: | ID |
| Postal Code: | 838159143 |
| Phone Number: | 2086919738 |
| Fax Number: | 2082637515 |
| NPI Enumeration Date: | 05/15/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LPC3268 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |