Provider Demographics
NPI:1366100711
Name:VIBRANT LIFE THERAPY LLC
Entity type:Organization
Organization Name:VIBRANT LIFE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:LEIGH DRIESSEN
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:406-600-3300
Mailing Address - Street 1:1807 W DICKERSON ST STE D
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-1311
Mailing Address - Country:US
Mailing Address - Phone:406-600-3300
Mailing Address - Fax:406-551-1055
Practice Address - Street 1:304 GALLATIN PARK DR UNIT 207
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-7945
Practice Address - Country:US
Practice Address - Phone:406-600-3300
Practice Address - Fax:406-404-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty