Healthcare Provider Details

I. General information

NPI: 1306595236
Provider Name (Legal Business Name): TIMBER WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13770 FRONTIER CT
BURNSVILLE MN
55337-4810
US

IV. Provider business mailing address

7881 W CHARLESTON BLVD STE 230
LAS VEGAS NV
89117-8327
US

V. Phone/Fax

Practice location:
  • Phone: 702-848-2256
  • Fax: 702-485-6746
Mailing address:
  • Phone: 702-508-2153
  • Fax: 702-508-2435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: GLEN REBMAN
Title or Position: OWNER
Credential: MD
Phone: 630-930-4014