Provider Demographics
NPI:1902207897
Name:PRIVATE REFLECTIONS COUNSELING, LLC
Entity Type:Organization
Organization Name:PRIVATE REFLECTIONS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:CANNON
Authorized Official - Last Name:GHULAMANI
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:352-388-4121
Mailing Address - Street 1:4623 NW 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-4857
Mailing Address - Country:US
Mailing Address - Phone:352-388-4121
Mailing Address - Fax:888-855-8123
Practice Address - Street 1:4623 NW 53RD AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-4857
Practice Address - Country:US
Practice Address - Phone:352-388-4121
Practice Address - Fax:888-855-8123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11918101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009272300Medicaid