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General NPI Number Information
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NPI Number | 1881066082
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Entity Type | Organization
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Legal Business Name | BEACON THERAPY LLC
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 22019 HIGHTOWER RD
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City | PASS CHRISTIAN
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State | MS
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Zip | 39571-9117
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Country | US
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Telephone | 228-254-7716
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2001
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City | LONG BEACH
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State | MS
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Zip | 39560-1900
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Country | US
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Telephone | 228-254-7716
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Fax |
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Authorized Official
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Title or Position | OWNER/SPEECH-LANGUAGE PATHOLOGIST
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Name | ELIZABETH BATTISE
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Credential | M.S., CCC-SLP
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Telephone | 228-254-7716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | S3733
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License Number State | MS
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