Phoenix Rebellion Therapy, LLC

NPI #1134759186 in Murray, Utah

Provider Information

NPI Number: 1134759186
Entity Type: Organization
Organization Name: Phoenix Rebellion Therapy, LLC
Primary Specialty: Social Worker - Clinical
Enumeration Date: Jan 17, 2020
Last Updated: Jan 18, 2023

Practice Location

Address: 4516 S 700 E STE 360
City: Murray
State: Utah
ZIP Code: 84107-8317
Phone: (385) 231-8387

Authorized Official

Name: ROD WALLER
Title: PRESIDENT/EXEC DIRECTOR
Phone: (385) 231-8387

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker - Clinical — Clinical	1041C0700X	Primary

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