=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518109677
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REFLECTIONS BEHAVIORAL HEALTH CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2009
-----------------------------------------------------
Last Update Date | 04/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 740 DERBY DR
-----------------------------------------------------
City | TARPON SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34689-8025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-234-3704
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 783
-----------------------------------------------------
City | TARPON SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34688-0783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-234-3704
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PCEO
-----------------------------------------------------
Name | MR. BRYAN D LEE
-----------------------------------------------------
Credential | M.A., LMHC
-----------------------------------------------------
Telephone | 727-234-3704
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | MH7947
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------