MEDICARE: REBEL HEART COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1003750969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBEL HEART COUNSELING, LLC

Provider Business Mailing Address
First Line	:	2201 E MAPLE ST # 2211
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-9997
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 E MAPLE ST # 2211
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-9997
Country	:	US
Telephone Number	:	330-238-8797
Fax Number	:

Authorized Official
Title or Position	:	LPC, OWNER
Name	:	CHRISTEN TAKACS
Credential	:	LPC
Telephone Number	:	330-238-8797

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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