Provider Demographics
NPI:1518755289
Name:SURRENDER THERAPY LLC
Entity type:Organization
Organization Name:SURRENDER THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUTUM
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:662-934-7168
Mailing Address - Street 1:15323 HIGHWAY 35 S
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-6843
Mailing Address - Country:US
Mailing Address - Phone:662-934-7168
Mailing Address - Fax:
Practice Address - Street 1:110 COMPRESS RD
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-7248
Practice Address - Country:US
Practice Address - Phone:662-934-7168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health