Organization
REBEL HEART THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MORGAN FITZ GIBBON LMFT (FOUNDER)
(971) 350-1122
Entity
Organization
Contact information
Practice address
11 NE MLK BLVD STE 203, PORTLAND, OR 97232-3579
(971) 350-1122
(971) 350-3401
Mailing address
11 NE MLK BLVD STE 203, PORTLAND, OR 97232-3579
(971) 350-1122
(971) 350-3401
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
106H00000X
Marriage & Family Therapist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/17/2020
Last updated
02/10/2022
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