NPIMap

Organization Active NPI

Rebel Heart Therapy LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Portland, OR
National Provider Identifier
1073146197
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
REBEL HEART THERAPY LLC
Practice address
11 NE MLK Blvd Ste 203
Portland, OR 97232-3579
Phone
(971) 350-1122
Fax
(971) 350-3401
NPI assigned
Feb 17, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Morgan Fitz Gibbon, LMFTNPI 1952738551
Title
Founder
Phone
(971) 350-1122

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X
Marriage & Family TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 106H00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Student in an Organized Health Care Education/Training ProgramGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 390200000X

Addresses

Primary practice location

11 NE MLK Blvd Ste 203
Portland, OR 97232-3579

Mailing address

11 NE MLK Blvd Ste 203
Portland, OR 97232-3579
Phone (971) 350-1122

National Provider Directory

National Provider Directory

Locations

811 E Burnside St
Ste 217
Portland, OR 97214
Phone (503) 432-3268

11 NE Mlk Blvd
Ste 203
Portland, OR 97232
Phone (971) 350-1122

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1073146197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 NE MLK BLVD STE 203",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972323579",
            "telephone_number": "971-350-1122",
            "fax_number": "971-350-3401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 NE MLK BLVD STE 203",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972323579",
            "telephone_number": "971-350-1122",
            "fax_number": "971-350-3401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REBEL HEART THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-17",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "FITZ GIBBON",
        "authorized_official_first_name": "MORGAN",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "971-350-1122",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.