| Phoenix Rebellion Therapy, Llc | |
|
4516 S 700 E Ste 360 Murray UT 84107-8317 | |
| (385) 231-8387 | |
| (385) 240-3843 |
| Full Name | Phoenix Rebellion Therapy, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 4516 S 700 E Ste 360, Murray, Utah |
| Authorized Official Name and Position | Rod Waller (PRESIDENT/EXEC DIRECTOR) |
| Authorized Official Contact | 3852318387 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Rebellion Therapy, Llc 4516 S 700 E Ste 360 Murray UT 84107-8317 Ph: (385) 231-8387 | Phoenix Rebellion Therapy, Llc 4516 S 700 E Ste 360 Murray UT 84107-8317 Ph: (385) 231-8387 |
| NPI Number | 1134759186 |
|---|---|
| Provider Enumeration Date | 01/17/2020 |
| Last Update Date | 01/18/2023 |
| Certification Date | 01/18/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134759186 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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