Organization
PHOENIX REBELLION THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROD WALLER (PRESIDENT/EXEC DIRECTOR)
(385) 231-8387
Entity
Organization
Contact information
Practice address
4516 S 700 E STE 360, MURRAY, UT 84107-8317
(385) 231-8387
(385) 240-3843
Mailing address
4516 S 700 E STE 360, MURRAY, UT 84107-8317
(385) 231-8387
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
01/17/2020
Last updated
01/18/2023
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