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General NPI Number Information
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NPI Number | 1831795095
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Entity Type | Organization
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Legal Business Name | BUTTERFLY AFFECT
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Dates
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Enumeration Date | 12/11/2020
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 4915 I 55 N FRONTAGE RD STE C 305
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City | JACKSON
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State | MS
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Zip | 39205
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Country | US
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Telephone | 769-226-6232
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 59053
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City | JACKSON
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State | MS
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Zip | 39284-9053
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Country | US
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Telephone | 769-226-6232
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JENNIFER GREEN
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Credential |
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Telephone | 769-226-6232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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