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General NPI Number Information
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NPI Number | 1902629454
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Entity Type | Organization
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Legal Business Name | SIMPLY REFLECTIVE THERAPY LLC
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 373 LANE 9
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City | POWELL
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State | WY
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Zip | 82435-8424
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Country | US
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Telephone | 307-306-5088
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Fax | 307-201-4770
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Provider Business Mailing Address
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Address Line | 373 LANE 9
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City | POWELL
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State | WY
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Zip | 82435-8424
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Country | US
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Telephone | 307-306-5088
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Fax | 307-201-4770
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | EMILY KAY GREEN
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Credential | LCSW
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Telephone | 307-259-3672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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