Healthcare Provider Details

I. General information

NPI: 1003750969
Provider Name (Legal Business Name): REBEL HEART COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 E MAPLE ST # 2211
NORTH CANTON OH
44720-9997
US

IV. Provider business mailing address

2201 E MAPLE ST # 2211
NORTH CANTON OH
44720-9997
US

V. Phone/Fax

Practice location:
  • Phone: 330-238-8797
  • 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

VIII. Authorized Official

Name: CHRISTEN TAKACS
Title or Position: LPCC, OWNER
Credential: LPCC
Phone: 330-238-8797