Desoto Family Counseling Center Pllc, NPI 1912214792
Community/Behavioral Health Agency in Southaven, MS, US

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NPI number: what is it?

The NPI, or National Provider Identifier, is a non-repeatable number for health care providers. The NPI always consists of 10 digits and is used for administrative and financial procedures. The NPI wa...

NPI 1912214792
NPI Entity Type Organization
Provider Name Desoto Family Counseling Center Pllc
Enumeration Date September 30, 2009
Last Update Date September 30, 2009
Certification Date September 30, 2009
Provider Location Address 8626 Airways Blvd, Southaven, MS, US
Provider Mailing Address 8626 Airways Blvd, Southaven, MS, US, 386712603
Gender Male
Is Sole Proprietor? No
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Organization Official

Official Name LPC-S Anthony Jerome Wood
Official Position OWNER
Phone 662-772-5937

Group Taxonomy

Taxonomy Code 193200000X
Taxonomy Name 193200000X MULTI-SPECIALTY GROUP
Definition A business group of one or more individual practitioners, who practice with different areas of specialization.

Primary Taxonomy

Taxonomy Code

251S00000X

Taxonomy Name Community/Behavioral Health Agency
Classification

Community/Behavioral Health

Group

Agencies

License No. 1326
License State MS
Description A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

Business Address

Desoto Family Counseling Center Pllc
8626 Airways Blvd

Southaven, MS, US

Phone: 662-772-5937
Fax: 662-772-5940

Mailing Address

Desoto Family Counseling Center Pllc
8626 Airways Blvd
Southaven, MS, US
ZIP 386712603
Phone: 662-772-5937
Fax: 662-772-5940

Secondary Taxonomies

Other Identifiers

Identifier Identifier State Identifier Issuer Type/Code
02332763 MS MEDICAID 05
03458834 MS MEDICAID 05
09250853 MS MEDICAID 05
04057773 MS MEDICAID 05
04073099 MS MEDICAID 05
09485302 MS MEDICAID 05
1558401521 MS MEDICAID 05
01128006 MS MEDICAID 05
03322249 MS MEDICAID 05
03350341 MS MEDICAID 05
05103380 MS MEDICAID 05
05476356 MS MEDICAID 05
09588552 MS MEDICAID 05
00432297 MS MEDICAID 05
01924277 MS MEDICAID 05
08579847 MS MEDICAID 05

Health Information Exchange

Endpoint Type Endpoint Description Use Content Type Affiliation Location
DIRECT [email protected] Credentialing Contact DIRECT OTHER No 8626 Airways Blvd, Southaven, MS, US

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