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REBEL HEART THERAPY LLC
NPI 1073146197
Clinic/Center - Mental Health (Including Community Mental Health Center) in Portland, OR

Active since February 17, 2020
11 NE MLK BLVD STE 203, PORTLAND, OR 97232(971) 350-1122(971) 350-3401 Get Directions Write a Review

NPPES record last updated: February 10, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 10, 2022, Apr 11, 2021, Feb 17, 2020 (3 updates tracked since 2020).

About Rebel Heart Therapy Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

REBEL HEART THERAPY LLC (NPI 1073146197) is a healthcare organization registered as a mental health (including community mental health center) in Portland, Oregon and active in the NPI registry since February 2020. The organization lists Morgan Fitz Gibbon, Founder, as its authorized official.

NPPES Registry Identity

NPI1073146197
Entity TypeOrganization
Primary Taxonomy261QM0801X
Legal Business NameREBEL HEART THERAPY LLC
Location Address11 NE MLK BLVD STE 203Portland, OR 97232-3579
Mailing Address11 Ne Mlk Blvd Ste 203Portland, OR 97232-3579 · (971) 350-1122 · Fax (971) 350-3401
Phone(971) 350-1122
Fax(971) 350-3401
Organization SubpartNo
Authorized OfficialMorgan Fitz GibbonFounder · (971) 350-1122
Enumeration DateFebruary 17, 2020
Last NPPES UpdateFebruary 10, 20223 updates tracked since enumeration
NPPES CertifiedFebruary 10, 2022
✔ NPI 1073146197 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyClinic/Center · Mental Health (Including Community Mental Health Center)Ambulatory Health Care Facilities
Taxonomy Code261QM0801X
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
Also ListedMarriage & Family TherapistTaxonomy 106H00000X
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
11 NE MLK BLVD STE 203, Portland, OR 97232
Open in Google Maps ↗

Group Practice 2

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP
Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOHN MATTHEW LIVENGOOD
Counselor (Mental Health)
11 NE MLK BLVD STE 203
PORTLAND, OR 97232
Multnomah County (971) 350-1122
TAMARA WERNER-FITZ GIBBON LPC, LMHC
Counselor (Mental Health)
11 NE MLK BLVD STE 203
PORTLAND, OR 97232
Multnomah County (971) 350-1122
KAI DEVA CARLI MA AT, ATR-P
Counselor (Mental Health)
11 NE MLK BLVD STE 203
PORTLAND, OR 97232
Multnomah County (971) 350-1122

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Rebel Heart Therapy LLC's NPI number?

The NPI number for Rebel Heart Therapy LLC is 1073146197. It was assigned to this organization in the NPPES registry on February 17, 2020.

Where is Rebel Heart Therapy LLC located?

Rebel Heart Therapy LLC is located at 11 NE Mlk Blvd Ste 203, Portland, OR 97232. The listed phone number is (971) 350-1122.

What is Rebel Heart Therapy LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.

When was this NPI record last updated?

The NPPES record for Rebel Heart Therapy LLC was last updated on February 10, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.