MEDICARE: BUTTERFLIES AND DOLPHINS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302F00000X	Exclusive Provider Organization	3570	CO
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	1521-01	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023026119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUTTERFLIES AND DOLPHINS, INC

Provider Business Mailing Address
First Line	:	735 SOUTH AVE
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-3639
Country	:	US
Telephone Number	:	970-242-1433
Fax Number	:	970-241-4379

Provider Business Practice Location Address
First Line	:	735 SOUTH AVE
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-3639
Country	:	US
Telephone Number	:	970-242-1433
Fax Number	:	970-241-4379

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. CAROL A MULLIGAN
Credential	:	MSCACIII
Telephone Number	:	970-242-1433

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	11/09/2011

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