Healthcare Provider Details

I. General information

NPI: 1073337440
Provider Name (Legal Business Name): DRAGONFLY WELLNESS AND EDUCATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W MAIN AVE
CHEWELAH WA
99109-9257
US

IV. Provider business mailing address

4107 PINE VIEW WAY
SPRINGDALE WA
99173-5005
US

V. Phone/Fax

Practice location:
  • Phone: 509-724-0221
  • Fax:
Mailing address:
  • Phone: 509-724-0221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SINAY BUTLER
Title or Position: OWNER
Credential:
Phone: 509-724-0221