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General NPI Number Information
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NPI Number | 1255717146
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Entity Type | Organization
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Legal Business Name | BEYOND REFLECTIONS THERAPEUTIC SERVICES, LLC
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Dates
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Enumeration Date | 08/03/2015
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Last Update Date | 07/30/2019
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Provider Practice Location Address
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Address Line | 3750 W MAIN ST STE 103
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City | NORMAN
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State | OK
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Zip | 73072-4669
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Country | US
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Telephone | 405-928-9058
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 720206
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City | NORMAN
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State | OK
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Zip | 73070-4157
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Country | US
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Telephone | 405-928-9058
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIDGITTE BONDZIE-LITTLEJOHN
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Credential | LCSW
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Telephone | 405-928-9058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4767
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License Number State | OK
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