Provider Demographics
NPI:1265989248
Name:GOLDEN REFLECTIONS, LLC
Entity type:Organization
Organization Name:GOLDEN REFLECTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANHOUTEN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:419-566-2891
Mailing Address - Street 1:PO BOX 877
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-0877
Mailing Address - Country:US
Mailing Address - Phone:419-566-2891
Mailing Address - Fax:567-393-9091
Practice Address - Street 1:7807 STATE ROUTE 309 LOT 1
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-9752
Practice Address - Country:US
Practice Address - Phone:419-566-2891
Practice Address - Fax:567-393-9480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI13023001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0217680Medicaid