=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780038661
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REFLECTIONS COUNSELING GROUP, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2016
-----------------------------------------------------
Last Update Date | 04/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 907 RIVERGATE PKWY SUITE A6
-----------------------------------------------------
City | GOODLETTSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37072-2324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-208-2772
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 907 RIVERGATE PKWY SUITE A6
-----------------------------------------------------
City | GOODLETTSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37072-2324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-208-2772
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | KEVILYNN GATSON
-----------------------------------------------------
Credential | LPC-MHSP
-----------------------------------------------------
Telephone | 615-499-8915
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 101YP2500X
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------