Provider Demographics
NPI:1902629454
Name:SIMPLY REFLECTIVE THERAPY LLC
Entity type:Organization
Organization Name:SIMPLY REFLECTIVE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:307-259-3672
Mailing Address - Street 1:373 LANE 9
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-8424
Mailing Address - Country:US
Mailing Address - Phone:307-306-5088
Mailing Address - Fax:307-201-4770
Practice Address - Street 1:373 LANE 9
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-8424
Practice Address - Country:US
Practice Address - Phone:307-306-5088
Practice Address - Fax:307-201-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health