Provider Demographics
NPI:1730794421
Name:REFLECT PLLC
Entity type:Organization
Organization Name:REFLECT PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/ BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:206-705-8595
Mailing Address - Street 1:226 SUMMIT AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-5619
Mailing Address - Country:US
Mailing Address - Phone:425-269-2461
Mailing Address - Fax:206-558-5659
Practice Address - Street 1:226 SUMMIT AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-5619
Practice Address - Country:US
Practice Address - Phone:425-269-2461
Practice Address - Fax:206-558-5659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2071895Medicaid