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Organization
DESOTO FAMILY WELLNESS CENTER, LLC
Active
Organization
DESOTO FAMILY WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY LYNN OLLAR (OFFICE MANAGER)
(662) 892-2885
Entity
Organization
Contact information
Practice address
3495 COBBLESTONE BLVD S, SOUTHAVEN, MS 38672-7075
(662) 892-2885
(662) 892-2889
Mailing address
3495 COBBLESTONE BLVD S, SOUTHAVEN, MS 38672-7075
(662) 892-2885
(662) 892-2889
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
103TC1900X
Counseling Psychologist
—
NULL
103TC1900X
Counseling Psychologist
—
—
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
NULL
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
10/30/2020
Last updated
09/18/2023
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