| Desoto Family Counseling Center Pllc | |
|
8626 Airways Blvd Southaven MS 38671-2603 | |
| (662) 772-5937 | |
| (662) 772-5940 |
| Full Name | Desoto Family Counseling Center Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 8626 Airways Blvd, Southaven, Mississippi |
| Authorized Official Name and Position | Anthony Jerome Wood (OWNER) |
| Authorized Official Contact | 6627725937 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desoto Family Counseling Center Pllc 8626 Airways Blvd Southaven MS 38671-2603 Ph: (662) 772-5937 | Desoto Family Counseling Center Pllc 8626 Airways Blvd Southaven MS 38671-2603 Ph: (662) 772-5937 |
| NPI Number | 1912214792 |
|---|---|
| Provider Enumeration Date | 09/01/2010 |
| Last Update Date | 02/24/2022 |
| Certification Date | 02/24/2022 |
| Medicare PECOS PAC ID | 1254511686 |
|---|---|
| Medicare Enrollment ID | O20110202000320 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912214792 | NPI | - | NPPES |
| 02332763 | Medicaid | MS | |
| 03458834 | Medicaid | MS | |
| 09250853 | Medicaid | MS | |
| 04057773 | Medicaid | MS | |
| 04073099 | Medicaid | MS | |
| 09485302 | Medicaid | MS | |
| 1558401521 | Medicaid | MS | |
| 01128006 | Medicaid | MS | |
| 03322249 | Medicaid | MS | |
| 03350341 | Medicaid | MS | |
| 05103380 | Medicaid | MS | |
| 05476356 | Medicaid | MS | |
| 09588552 | Medicaid | MS | |
| 00432297 | Medicaid | MS | |
| 01924277 | Medicaid | MS | |
| 08579847 | Medicaid | MS |
| Provider Name | Margaret A Wallace |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700110764 PECOS PAC ID: 6204141450 Enrollment ID: I20150817001990 |
| Provider Name | Christa C Dunlop |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063093870 PECOS PAC ID: 0547651630 Enrollment ID: I20211228001344 |
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