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General NPI Number Information
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NPI Number | 1518755289
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Entity Type | Organization
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Legal Business Name | SURRENDER THERAPY LLC
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 110 COMPRESS RD
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City | BATESVILLE
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State | MS
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Zip | 38606-7248
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Country | US
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Telephone | 662-934-7168
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Fax |
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Provider Business Mailing Address
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Address Line | 15323 HIGHWAY 35 S
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City | BATESVILLE
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State | MS
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Zip | 38606-6843
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Country | US
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Telephone | 662-934-7168
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AUTUM NICOLE PIERCE
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Credential | LCSW
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Telephone | 662-934-7168
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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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