Provider Demographics
NPI:1972113124
Name:REBIRTH MENTAL HEALTH SERVICES, INC
Entity type:Organization
Organization Name:REBIRTH MENTAL HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:FARMER
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:985-774-4989
Mailing Address - Street 1:202 VILLAGE CIR STE 3
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5418
Mailing Address - Country:US
Mailing Address - Phone:985-774-4989
Mailing Address - Fax:985-288-5466
Practice Address - Street 1:202 VILLAGE CIR STE 3
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-5418
Practice Address - Country:US
Practice Address - Phone:985-774-4989
Practice Address - Fax:985-288-5466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty