MEDICARE: BUTTERFLY SUPPORT SERVICES

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1932752904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUTTERFLY SUPPORT SERVICES

Provider Business Mailing Address
First Line	:	55 E MONROE ST STE 38109
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60603-5713
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7373 BROOKCREST DR # RC333
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-3446
Country	:	US
Telephone Number	:	513-802-5642
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	EDWARD THOMPSON
Credential	:
Telephone Number	:	312-881-7547

Provider Enumeration Date	:	07/18/2019
Last Update Date	:	10/01/2020

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Directions to “BUTTERFLY SUPPORT SERVICES ” Practice Location

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