Healthcare Provider Details

I. General information

NPI: 1871057000
Provider Name (Legal Business Name): VIBRANT LIFE PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 NIGHT STAR TER
PARRISH FL
34219-2066
US

IV. Provider business mailing address

3411 NIGHT STAR TER
PARRISH FL
34219-2066
US

V. Phone/Fax

Practice location:
  • Phone: 240-301-2711
  • Fax: 239-758-8291
Mailing address:
  • Phone: 240-301-2711
  • Fax: 239-758-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA LEE REBHOLZ
Title or Position: THERAPIST
Credential:
Phone: 240-301-2711