Provider Demographics
NPI:1255142485
Name:BUTTERFLY COUNSELING SERVICES AND OUTREACH PROGRAM
Entity type:Organization
Organization Name:BUTTERFLY COUNSELING SERVICES AND OUTREACH PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LASONYA
Authorized Official - Middle Name:C
Authorized Official - Last Name:FORD-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:870-275-3513
Mailing Address - Street 1:4808 HIGHLAND PARK CIR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6724
Mailing Address - Country:US
Mailing Address - Phone:870-275-3513
Mailing Address - Fax:
Practice Address - Street 1:4808 HIGHLAND PARK CIR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6724
Practice Address - Country:US
Practice Address - Phone:870-275-3513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)