=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578224036
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REFLECTED ESSENCE COUNSELING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2022
-----------------------------------------------------
Last Update Date | 01/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3139 W HOLCOMBE BLVD STE 2104
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77025-1533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 737-241-8677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3294
-----------------------------------------------------
City | PEARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77588-3294
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 737-241-8677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KYRBI A DAVIS
-----------------------------------------------------
Credential | LCSW, LCDC
-----------------------------------------------------
Telephone | 737-241-8677
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------