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General NPI Number Information
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NPI Number | 1215705256
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Entity Type | Organization
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Legal Business Name | BECOMING UNDONE THERAPY SERVICES LLC
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Dates
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Enumeration Date | 12/19/2023
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 4010 OFERRAL ST STE 209
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City | HATTIESBURG
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State | MS
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Zip | 39402-1613
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Country | US
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Telephone | 601-463-8418
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Fax |
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Provider Business Mailing Address
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Address Line | 4208 HIGHWAY 8 E
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City | OKOLONA
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State | MS
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Zip | 38860-9390
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANIA BARR
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Credential | LPC
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Telephone | 601-447-2321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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