Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Phoenix Rebellion Therapy, LLC

Organization Clinical Social Worker · NPI 1134759186

Phoenix Rebellion Therapy, LLC is a Clinical Social Worker in Murray, Utah. Works from 2 locations. Registered with an NPI since 2020.

In the registry since
2020
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4516 S 700 E Ste 360
Murray, UT 84107-8317
Phone: (385) 231-8387
Fax: (385) 240-3843
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 347 N 300 W Ste 201, Kaysville, UT 84037-1828 — (385) 231-8387

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X

Record details

NPI number1134759186
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Rod Waller — President/Exec Director · (385) 231-8387
NPI enumeratedJanuary 17, 2020
Last updated in NPPESJanuary 18, 2023
Certification dateJanuary 18, 2023
Mailing address4516 S 700 E Ste 360, Murray, UT 84107-8317

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