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General NPI Number Information
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NPI Number | 1871113589
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Entity Type | Organization
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Legal Business Name | BUTTERFLY AFFECT PSYCHOTHERAPY & COUNSELING, LLC
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 703 WALNUT ST
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City | BOULDER
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State | CO
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Zip | 80302-5032
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Country | US
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Telephone | 303-351-2362
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Fax |
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Provider Business Mailing Address
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Address Line | 3328 34TH ST
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City | BOULDER
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State | CO
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Zip | 80301-1908
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ABIGAIL WHITE
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Credential | MA, RP
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Telephone | 203-536-0813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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