Provider Demographics
NPI:1205526449
Name:BEYOND THE BROKENNESS MENTAL WELNESS SOLUTIONS, LLC
Entity type:Organization
Organization Name:BEYOND THE BROKENNESS MENTAL WELNESS SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANYELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-596-8937
Mailing Address - Street 1:PO BOX 18974
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-8974
Mailing Address - Country:US
Mailing Address - Phone:601-596-8937
Mailing Address - Fax:
Practice Address - Street 1:1000 TURTLE CREEK DR STE 90
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1165
Practice Address - Country:US
Practice Address - Phone:601-596-8937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)