Healthcare Provider Details

I. General information

NPI: 1396478053
Provider Name (Legal Business Name): REBEL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W COUNTY LINE RD STE 250
HIGHLANDS RANCH CO
80129-2342
US

IV. Provider business mailing address

10189 QUARRY HILL PL
PARKER CO
80134-3748
US

V. Phone/Fax

Practice location:
  • Phone: 303-946-7683
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOEL RIECK
Title or Position: CEO
Credential:
Phone: 303-946-7683