Healthcare Provider Details

I. General information

NPI: 1841109956
Provider Name (Legal Business Name): ELEPHANT IN THE ROOM THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15400 SWAN LAKE BLVD
GULFPORT MS
39503-8286
US

IV. Provider business mailing address

15400 SWAN LAKE BLVD
GULFPORT MS
39503-8286
US

V. Phone/Fax

Practice location:
  • Phone: 228-297-6485
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: ELIZABETH M BECKER
Title or Position: SOCIAL WORKER
Credential: LCSW
Phone: 228-297-6485