Provider Demographics
NPI:1548711567
Name:REFLECTIVE PSYCHOTHERAPY
Entity type:Organization
Organization Name:REFLECTIVE PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-454-4916
Mailing Address - Street 1:13710 E RICE PL
Mailing Address - Street 2:200
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-1074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13710 E RICE PL
Practice Address - Street 2:200
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1074
Practice Address - Country:US
Practice Address - Phone:720-434-1846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004618101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty