Provider Demographics
NPI:1932993318
Name:DYNAMIC REFLECTIONS
Entity type:Organization
Organization Name:DYNAMIC REFLECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:660-624-3624
Mailing Address - Street 1:1047 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5204
Mailing Address - Country:US
Mailing Address - Phone:660-624-3624
Mailing Address - Fax:
Practice Address - Street 1:1047 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5204
Practice Address - Country:US
Practice Address - Phone:661-788-5354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty