=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790165777
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REFLECTIONS COUNSELING CENTER OF COLUMBUS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2015
-----------------------------------------------------
Last Update Date | 06/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1550 OLD HENDERSON RD SUITE N-246
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43220-3626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-390-6482
-----------------------------------------------------
Fax | 614-453-8573
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1550 OLD HENDERSON RD SUITE N-246
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43220-3626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-390-6482
-----------------------------------------------------
Fax | 614-453-8573
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ELIZABETH MARIA OLATE
-----------------------------------------------------
Credential | LISW-S
-----------------------------------------------------
Telephone | 614-390-6482
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | I.1101252.SUPV
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------