Provider Demographics
NPI:1962810879
Name:THE BUTTERFLY AFFECT THERAPY SERVICES, INC
Entity type:Organization
Organization Name:THE BUTTERFLY AFFECT THERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MITZI
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAPILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:786-203-5848
Mailing Address - Street 1:10211 PINES BLVD # 212
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-6003
Mailing Address - Country:US
Mailing Address - Phone:786-203-5848
Mailing Address - Fax:888-369-3691
Practice Address - Street 1:10211 PINES BLVD # 212
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-6003
Practice Address - Country:US
Practice Address - Phone:786-203-5848
Practice Address - Fax:888-369-3691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000698500Medicaid