| Provider / Organization | NPI | Date Certified |
|---|---|---|
| REBEL HEART THERAPY LLC | 1073146197 | 2022-02-10 |
The organization Rebel Heart Therapy Llc is registered with the National Plan and Provider Enumeration System (NPPES) and has the assigned NPI of 1073146197. Registration indicates Rebel Heart Therapy Llc is a provider of access to mental health/behavioral health providers services with a specialization in Behavioral Health & Social Service Providers, Counselor (Behavioral Health & Social Service Providers, Counselor) (Counselor: Mental Health, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Counselor Mental Health, Behavioral Health & Social Service Providers) (Counselor, ) (Behavioral Health & Social Service Providers, Marriage & Family Therapist) (Marriage & Family Therapist, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Marriage & Family Therapist, Behavioral Health & Social Service Providers) (Ambulatory Health Care Facilities, Clinic/Center) (Clinic/Center: Mental Health (Including Community Mental Health Center),, ) (Community Mental Health Center, ) (Clinic/Center Mental Health (Including Community Mental Health Center),, Ambulatory Health Care Facilities) (Clinic/Center, ) (Student, Health Care, Student in an Organized Health Care Education/Training Program) (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care)
| Address | City / State | Phone / Fax |
|---|---|---|
| 1020 SW Taylor St Ste 700 | Portland, OR 972052512 | 9713501122 |
| Code | Practice | License No State |
|---|---|---|
| 101YM0800X | Access to Mental Health/Behavioral Health Providers Behavioral Health & Social Service Providers Counselor Behavioral Health & Social Service Providers Counselor Counselor: Mental Health Behavioral Health/Substance Abuse/Psychiatry Counselor Mental Health Behavioral Health & Social Service Providers Counselor | |
| 106H00000X | Behavioral Health & Social Service Providers Marriage & Family Therapist Marriage & Family Therapist Behavioral Health/Substance Abuse/Psychiatry Marriage & Family Therapist Behavioral Health & Social Service Providers | |
| 261QM0801X PRIMARY | Ambulatory Health Care Facilities Clinic/Center Clinic/Center: Mental Health (Including Community Mental Health Center), Community Mental Health Center Clinic/Center Mental Health (Including Community Mental Health Center), Ambulatory Health Care Facilities Clinic/Center | |
| 390200000X | Student, Health Care Student in an Organized Health Care Education/Training Program Student in an Organized Health Care Education/Training Program All Other Specialties & Provider Types Student in an Organized Health Care Education/Training Program Student, Health Care | |
| 193400000X MULT | Group Code | |
| 193400000X SING | Group Code | |
| 193400000X MULT | Group Code |