Healthcare Provider Details

I. General information

NPI: 1871250001
Provider Name (Legal Business Name): THERAPY FOR REBELS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 ESCALANTE DR APT 8310
DURANGO CO
81303-8929
US

IV. Provider business mailing address

361 S CAMINO DEL RIO # 288
DURANGO CO
81303-7997
US

V. Phone/Fax

Practice location:
  • Phone: 720-312-3278
  • Fax:
Mailing address:
  • Phone: 720-312-3278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JESSICA DISBROW
Title or Position: OWNER
Credential: MSW, LCSW
Phone: 720-312-3278