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General NPI Number Information
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NPI Number | 1750560868
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Entity Type | Organization
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Legal Business Name | REFLECTIONS FRO YOUTH, INC.
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 1000 S LINCOLN AVE 190-200
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City | LOVELAND
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State | CO
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Zip | 80537-6358
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Country | US
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Telephone | 970-344-1380
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Fax | 970-344-1394
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Provider Business Mailing Address
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Address Line | PO BOX 1860
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City | BERTHOUD
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State | CO
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Zip | 80513-1860
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Country | US
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Telephone | 970-344-1380
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Fax | 970-344-1394
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Authorized Official
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Title or Position | FINANCIAL ADMINISTRATOR
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Name | CAROL S JOHNSON
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Credential | LMFT
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Telephone | 970-344-1380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 1530131
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License Number State | CO
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