Provider Demographics
NPI:1962254912
Name:BLACK BUTTERFLY WELLNESS, PLLC
Entity type:Organization
Organization Name:BLACK BUTTERFLY WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARETHA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:510-332-5042
Mailing Address - Street 1:5473 BLAIR RD, STE 100
Mailing Address - Street 2:#198663
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231
Mailing Address - Country:US
Mailing Address - Phone:510-332-5042
Mailing Address - Fax:
Practice Address - Street 1:4130 ELLINGER DR
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75126-3721
Practice Address - Country:US
Practice Address - Phone:510-332-5042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health