Provider Demographics
NPI:1235475856
Name:BUTTERFLY EFFECTS
Entity Type:Organization
Organization Name:BUTTERFLY EFFECTS
Other - Org Name:NONE
Other - Org Type:Other Name
Authorized Official - Title/Position:BEHAVIORAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:DARNELL
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-565-0042
Mailing Address - Street 1:4650 34TH STREET APT D
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116
Mailing Address - Country:US
Mailing Address - Phone:619-565-0042
Mailing Address - Fax:
Practice Address - Street 1:4650 34TH ST APT D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-3443
Practice Address - Country:US
Practice Address - Phone:619-565-0042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care