Healthcare Provider Details

I. General information

NPI: 1003612698
Provider Name (Legal Business Name): BLACK BUTTERFLY GROWTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 BAXTER AVE STE 1
LOUISVILLE KY
40204-1605
US

IV. Provider business mailing address

1017 BAXTER AVE STE 1
LOUISVILLE KY
40204-1605
US

V. Phone/Fax

Practice location:
  • Phone: 502-500-2875
  • Fax:
Mailing address:
  • Phone: 502-500-2875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TRANIECE MARIE DUNCAN
Title or Position: OWNER
Credential: APRN
Phone: 502-500-2875