Provider Demographics
NPI:1083250039
Name:REFLECTIVE WELLNESS MIND AND BODY
Entity Type:Organization
Organization Name:REFLECTIVE WELLNESS MIND AND BODY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LETITIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MCC LPC
Authorized Official - Phone:303-257-3746
Mailing Address - Street 1:13731 E RICE PL STE 200
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-1077
Mailing Address - Country:US
Mailing Address - Phone:303-257-3746
Mailing Address - Fax:720-639-2317
Practice Address - Street 1:13731 E RICE PL STE 200
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1077
Practice Address - Country:US
Practice Address - Phone:720-949-1707
Practice Address - Fax:720-639-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37554522Medicaid