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General NPI Number Information
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NPI Number | 1518644814
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Entity Type | Organization
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Legal Business Name | REBIRTH CENTER
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Dates
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Enumeration Date | 06/29/2023
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 5008 W GLENDALE AVE STE 110
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City | GLENDALE
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State | AZ
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Zip | 85301-2751
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Country | US
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Telephone | 602-731-5188
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Fax |
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Provider Business Mailing Address
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Address Line | 9023 W HUBBELL ST
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City | PHOENIX
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State | AZ
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Zip | 85037-3882
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Country | US
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Telephone | 602-731-5188
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Fax |
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Authorized Official
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Title or Position | ADM
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Name | LESLIE JONES
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Credential | BHT
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Telephone | 602-731-5188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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