Provider Demographics
NPI:1952060774
Name:THE REST ROOM THERAPIES LLC
Entity Type:Organization
Organization Name:THE REST ROOM THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:662-213-8479
Mailing Address - Street 1:1105 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-2515
Mailing Address - Country:US
Mailing Address - Phone:662-213-8479
Mailing Address - Fax:
Practice Address - Street 1:1105 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-2515
Practice Address - Country:US
Practice Address - Phone:662-213-8479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty