MEDICARE: REFLECTION FAMILY SERVICES INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	CSLG6160	AZ

General Provider Information

NPI Number	:	1306294046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REFLECTION FAMILY SERVICES INC.

Provider Business Mailing Address
First Line	:	2530 E BROADWAY BLVD STE A
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-5334
Country	:	US
Telephone Number	:	520-795-0981
Fax Number	:	520-795-0924

Provider Business Practice Location Address
First Line	:	2530 E BROADWAY BLVD STE A
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-5334
Country	:	US
Telephone Number	:	520-795-0981
Fax Number	:	520-795-0924

Authorized Official
Title or Position	:	CEO
Name	:	TERRY ANN STOE-BEDOYA
Credential	:	MS
Telephone Number	:	520-631-0183

Provider Enumeration Date	:	06/02/2016
Last Update Date	:	06/02/2016

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