Healthcare Provider Details

I. General information

NPI: 1023026119
Provider Name (Legal Business Name): BUTTERFLIES AND DOLPHINS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 SOUTH AVE
GRAND JUNCTION CO
81501-3639
US

IV. Provider business mailing address

735 SOUTH AVE
GRAND JUNCTION CO
81501-3639
US

V. Phone/Fax

Practice location:
  • Phone: 970-242-1433
  • Fax: 970-241-4379
Mailing address:
  • Phone: 970-242-1433
  • Fax: 970-241-4379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number3570
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1521-01
License Number StateCO

VIII. Authorized Official

Name: MS. CAROL A MULLIGAN
Title or Position: EXECUTIVE DIRECTOR
Credential: MSCACIII
Phone: 970-242-1433