=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720630791
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REFLECTIVE THERAPEUTIC SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2019
-----------------------------------------------------
Last Update Date | 07/10/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8400 S KYRENE RD STE 116
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85284-2119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-717-2403
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8400 S KYRENE RD STE 116
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85284-2119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-717-2403
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. TIFFANY WILLIAMS-JONES
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 480-717-2403
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------