MEDICARE: INFINITE BUTTERFLY THERAPY GROUP

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1164025813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITE BUTTERFLY THERAPY GROUP

Provider Business Mailing Address
First Line	:	3205 N WILKE RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-0001
Country	:	US
Telephone Number	:	224-764-0729
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 N WILKE RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-0001
Country	:	US
Telephone Number	:	224-764-0729
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LINDABETH RIVERA
Credential	:
Telephone Number	:	773-829-3409

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	11/17/2020

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