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General NPI Number Information
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NPI Number | 1689458598
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Entity Type | Organization
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Legal Business Name | PURPLEBUTTERFLY, LLC
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Dates
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Enumeration Date | 08/22/2023
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 90 W LAKEVIEW DR.
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City | CLINTON
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State | MS
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Zip | 39056-5266
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Country | US
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Telephone | 662-586-1815
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Fax | 769-241-0062
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Provider Business Mailing Address
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Address Line | PO BOX 1142
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City | CLINTON
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State | MS
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Zip | 39060-1142
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Country | US
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Telephone | 601-622-6260
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TRACEY MARSHALL
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Credential |
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Telephone | 662-586-1815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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