Healthcare Provider Details

I. General information

NPI: 1932752904
Provider Name (Legal Business Name): BUTTERFLY SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 BROOKCREST DR # RC333
CINCINNATI OH
45237-3446
US

IV. Provider business mailing address

55 E MONROE ST STE 38109
CHICAGO IL
60603-5713
US

V. Phone/Fax

Practice location:
  • Phone: 513-802-5642
  • 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

VIII. Authorized Official

Name: EDWARD THOMPSON
Title or Position: DIRECTOR
Credential:
Phone: 312-881-7547