Provider Demographics
NPI:1023026119
Name:BUTTERFLIES AND DOLPHINS, INC
Entity Type:Organization
Organization Name:BUTTERFLIES AND DOLPHINS, INC
Other - Org Name:INNER JOURNEY COMMUNITY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MULLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSCACIII
Authorized Official - Phone:970-242-1433
Mailing Address - Street 1:735 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3639
Mailing Address - Country:US
Mailing Address - Phone:970-242-1433
Mailing Address - Fax:970-241-4379
Practice Address - Street 1:735 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3639
Practice Address - Country:US
Practice Address - Phone:970-242-1433
Practice Address - Fax:970-241-4379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1521-01101YA0400X
CO3570302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55285082Medicaid