Provider Demographics
NPI:1720616600
Name:CENTER FOR REFLECTIVE PRACTICE
Entity Type:Organization
Organization Name:CENTER FOR REFLECTIVE PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-369-5050
Mailing Address - Street 1:PO BOX 421146
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92142-1146
Mailing Address - Country:US
Mailing Address - Phone:619-369-5050
Mailing Address - Fax:877-485-5961
Practice Address - Street 1:9606 TIERRA GRANDE ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-6501
Practice Address - Country:US
Practice Address - Phone:619-369-5050
Practice Address - Fax:877-485-5961
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR THOUGHTFUL LASTING CHANGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty