Provider Demographics
NPI:1386274306
Name:DANCING THISTLE LLC
Entity type:Organization
Organization Name:DANCING THISTLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:509-933-2246
Mailing Address - Street 1:22 SAND POINT SHORES DR
Mailing Address - Street 2:
Mailing Address - City:EAST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-4739
Mailing Address - Country:US
Mailing Address - Phone:508-933-2246
Mailing Address - Fax:
Practice Address - Street 1:197 PALMER AVE
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2806
Practice Address - Country:US
Practice Address - Phone:508-933-2246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty