MEDICARE: REFLECTIONS COUNSELING CENTER OF COLUMBUS

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	1041C0700X	Clinical Social Worker	I.1101252.SUPV	OH

General Provider Information

NPI Number	:	1790165777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REFLECTIONS COUNSELING CENTER OF COLUMBUS

Provider Business Mailing Address
First Line	:	1550 OLD HENDERSON RD
Second Line	:	SUITE N-246
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3626
Country	:	US
Telephone Number	:	614-390-6482
Fax Number	:	614-453-8573

Provider Business Practice Location Address
First Line	:	1550 OLD HENDERSON RD
Second Line	:	SUITE N-246
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3626
Country	:	US
Telephone Number	:	614-390-6482
Fax Number	:	614-453-8573

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELIZABETH MARIA OLATE
Credential	:	LISW-S
Telephone Number	:	614-390-6482

Provider Enumeration Date	:	06/04/2015
Last Update Date	:	06/04/2015

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