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Organization
PORCHLIGHT MARRIAGE AND FAMILY THERAPY
Active
Organization
PORCHLIGHT MARRIAGE AND FAMILY THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN THOMAS WILDEMAN LMFT (OWNER)
(662) 205-0197
Entity
Organization
Contact information
Practice address
113 CLARK ST STE 1, TUPELO, MS 38804-4809
(662) 205-0197
(662) 346-2821
Mailing address
PO BOX 132, TUPELO, MS 38802-0132
(662) 205-0197
(662) 346-2821
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
NULL
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
05/05/2026
Last updated
05/05/2026
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