REBEL HEART THERAPY LLC NPI 1073146197

NPI Information

NPI: 1073146197
Provider Name: REBEL HEART THERAPY LLC
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
11 NE MLK BLVD STE 203
PORTLAND, OR
ZIP 97232
Phone: (971) 350-1122
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REBEL HEART THERAPY LLC is a mental health (including community mental health center) clinic center in Portland, OR. REBEL HEART THERAPY LLC NPI is 1073146197. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

11 NE MLK BLVD STE 203
PORTLAND, OR
ZIP 97232-579
Phone: (971) 350-1122
Fax: (971) 350-3401

The provider's authorized official is Morgan Fitz Gibbon .
The authorized official title is Founder and has the following contact phone number (971) 350-1122.

The enumeration date for this NPI number is 2/17/2020 and was last updated on 2/10/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	390200000X	Student in an Organized Health Care Education/Training Program		No
2	101YM0800X	Counselor	Mental Health	No
3	106H00000X	Marriage & Family Therapist		No
4	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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