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

Rebel Heart Therapy LLC

Organization Mental Health Counselor · NPI 1073146197

Rebel Heart Therapy LLC is a Mental Health Counselor in Portland, Oregon. Registered with an NPI since 2020.

In the registry since
2020
Specialties on file
4
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

11 NE Mlk Blvd Ste 203
Portland, OR 97232-3579
Phone: (971) 350-1122
Fax: (971) 350-3401
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Clinic/Center (Including Community Mental Health Center) (primary) Taxonomy 261QM0801X
Mental Health Counselor Taxonomy 101YM0800X
Marriage & Family Therapist Taxonomy 106H00000X
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1073146197
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Morgan Fitz Gibbon — Founder · (971) 350-1122
NPI enumeratedFebruary 17, 2020
Last updated in NPPESFebruary 10, 2022
Certification dateFebruary 10, 2022
Mailing address11 Ne Mlk Blvd Ste 203, Portland, OR 97232-3579

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