MEDICARE: BUTTERFLY EFFECTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	39339031	TX

General Provider Information

NPI Number	:	1952858904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUTTERFLY EFFECTS

Provider Business Mailing Address
First Line	:	14333 PHILIPPINE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-6913
Country	:	US
Telephone Number	:	309-648-1837
Fax Number	:

Provider Business Practice Location Address
First Line	:	14333 PHILIPPINE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-6913
Country	:	US
Telephone Number	:	309-648-1837
Fax Number	:

Authorized Official
Title or Position	:	ABA THERAPY
Name	:	ANDREA CELESTE YOUNG
Credential	:
Telephone Number	:	309-648-1837

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	09/07/2016

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Directions to “BUTTERFLY EFFECTS ” Practice Location

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