Organization
REBEL CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KUSUM JAGDISH CHANRAI (GENERAL MANAGER)
(857) 756-7678
Entity
Organization
Contact information
Practice address
2 N CENTRAL AVE STE 1800, PHOENIX, AZ 85004-2139
(857) 756-7678
Mailing address
2 N CENTRAL AVE STE 1800, PHOENIX, AZ 85004-2139
(857) 756-7678
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1841434123
CLINICAL PSYCHOLOGIST
AZ
Enumeration date
11/27/2023
Last updated
08/08/2024
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