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General NPI Number Information
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NPI Number | 1104578806
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Entity Type | Organization
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Legal Business Name | REFLECTIVE WELLNESS MIND AND BODY
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 280 E COLFAX AVE
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City | BENNETT
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State | CO
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Zip | 80102-5003
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Country | US
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Telephone | 303-257-3746
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Fax |
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Provider Business Mailing Address
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Address Line | 13731 E RICE PL STE 200
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City | AURORA
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State | CO
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Zip | 80015-1077
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Country | US
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Telephone | 720-949-1707
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Fax | 720-639-2317
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Authorized Official
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Title or Position | OWNDER
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Name | LETITIA JACKSON
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Credential | LPC
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Telephone | 720-949-2317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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