Provider Demographics
NPI:1275063661
Name:HEART REFLECTIONS, L.L.C.
Entity Type:Organization
Organization Name:HEART REFLECTIONS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TALITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:EASTERLY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:517-225-4373
Mailing Address - Street 1:PO BOX 24081
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909-4081
Mailing Address - Country:US
Mailing Address - Phone:517-225-4373
Mailing Address - Fax:
Practice Address - Street 1:1151 MICHIGAN AVE STE 108
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4078
Practice Address - Country:US
Practice Address - Phone:517-225-4373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017005103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty