# PORCHLIGHT MARRIAGE AND FAMILY THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043147119
- **Authorized official:** MARTIN THOMAS WILDEMAN LMFT (OWNER)
- **Authorized official phone:** (662) 205-0197

## Contact information

- **Practice address:** 113 CLARK ST STE 1, TUPELO, MS 38804-4809
- **Practice address phone:** (662) 205-0197
- **Practice address fax:** (662) 346-2821
- **Mailing address:** PO BOX 132, TUPELO, MS 38802-0132
- **Mailing address phone:** (662) 205-0197
- **Mailing address fax:** (662) 346-2821

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 05/05/2026
- **Last updated:** 05/05/2026