MEDICARE: PROFOUND REFLECTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251G00000X	Community Based Hospice Care Agency
3	251S00000X	Community/Behavioral Health Agency
4	251X00000X	Supports Brokerage Agency
5	252Y00000X	Early Intervention Provider Agency
6	253Z00000X	In Home Supportive Care Agency
7	261QD1600X	Developmental Disabilities Clinic/Center
8	282J00000X	Religious Nonmedical Health Care Institution
9	302R00000X	Health Maintenance Organization
10	305R00000X	Preferred Provider Organization
11	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
12	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1134976996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFOUND REFLECTIONS

Provider Business Mailing Address
First Line	:	1734 WICKFORD RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44112-1208
Country	:	US
Telephone Number	:	216-374-1546
Fax Number	:

Provider Business Practice Location Address
First Line	:	1734 WICKFORD RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44112-1208
Country	:	US
Telephone Number	:	216-374-1546
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. LEAH WALLACE
Credential	:
Telephone Number	:	216-374-1546

Provider Enumeration Date	:	05/01/2024
Last Update Date	:	05/01/2024

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Directions to “PROFOUND REFLECTIONS ” Practice Location

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