Healthcare Provider Details

I. General information

NPI: 1912456856
Provider Name (Legal Business Name): REFLECTIONS ACADEMY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 HARLOW RD
THOMPSON FALLS MT
59873
US

IV. Provider business mailing address

P.O. BOX 1713 171 HARLOW RD
THOMPSON FALLS MT
59873
US

V. Phone/Fax

Practice location:
  • Phone: 406-827-5591
  • Fax:
Mailing address:
  • Phone: 406-827-5591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberPAP-PAP-LIC-614
License Number StateMT

VIII. Authorized Official

Name: MICKEY MANNING
Title or Position: CEO
Credential:
Phone: 805-886-4223