Healthcare Provider Details

I. General information

NPI: 1871113589
Provider Name (Legal Business Name): BUTTERFLY AFFECT PSYCHOTHERAPY & COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 WALNUT ST
BOULDER CO
80302-5032
US

IV. Provider business mailing address

3328 34TH ST
BOULDER CO
80301-1908
US

V. Phone/Fax

Practice location:
  • Phone: 303-351-2362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABIGAIL WHITE
Title or Position: PRESIDENT
Credential: MA, RP
Phone: 203-536-0813