Healthcare Provider Details

I. General information

NPI: 1043078058
Provider Name (Legal Business Name): ROCKY MOUNTAIN REFLECTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 OFFICE CLUB PT STE 113
COLORADO SPRINGS CO
80920-5012
US

IV. Provider business mailing address

1880 OFFICE CLUB PT STE 113
COLORADO SPRINGS CO
80920-5012
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA SHOLTS
Title or Position: OWNER
Credential: LPC
Phone: 701-388-9783