Provider Demographics
NPI:1649032327
Name:BEAUTIFUL REFLECTIONS MARRIAGE AND FAMILY THERAPY PROF CORP
Entity type:Organization
Organization Name:BEAUTIFUL REFLECTIONS MARRIAGE AND FAMILY THERAPY PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNCH-LIPSCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:760-514-6853
Mailing Address - Street 1:18484 US HIGHWAY 18 STE 210
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2319
Mailing Address - Country:US
Mailing Address - Phone:760-514-6853
Mailing Address - Fax:760-946-9110
Practice Address - Street 1:18484 US HIGHWAY 18 STE 210
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2319
Practice Address - Country:US
Practice Address - Phone:760-514-6853
Practice Address - Fax:760-946-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty