Provider Demographics
NPI:1538672712
Name:REFLECTIONS OUTPATIENT
Entity Type:Organization
Organization Name:REFLECTIONS OUTPATIENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:SUDC, SAP
Authorized Official - Phone:801-441-7144
Mailing Address - Street 1:20 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-1939
Mailing Address - Country:US
Mailing Address - Phone:801-441-7144
Mailing Address - Fax:
Practice Address - Street 1:20 S STATE ST
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-1939
Practice Address - Country:US
Practice Address - Phone:801-441-7144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT54255324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility