Healthcare Provider Details

I. General information

NPI: 1083492334
Provider Name (Legal Business Name): BEAUTIFUL BUTTERFLY COMMUNITY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4016 W SLAUSON AVE
LOS ANGELES CA
90043-2804
US

IV. Provider business mailing address

4016 W SLAUSON AVE
LOS ANGELES CA
90043-2804
US

V. Phone/Fax

Practice location:
  • Phone: 213-277-7185
  • Fax:
Mailing address:
  • Phone: 213-277-7185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. WILLISHIA JOHNSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LMFT
Phone: 213-277-7185