Organization
DESOTO FAMILYCOUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA C WOOD (OFFICE MANAGER)
(662) 772-5937
Entity
Organization
Contact information
Practice address
6858 SWINNEA RD, BUILDING 4, SOUTHAVEN, MS 38671-9493
(662) 772-5937
(662) 772-5940
Mailing address
6858 SWINNEA RD, BUILDING 4, SOUTHAVEN, MS 38671-9493
(662) 772-5937
(662) 772-5940
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
11/15/2016
Last updated
11/15/2016
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