Organization
DESOTO FAMILY COUNSELING CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY JEROME WOOD LPC-S (OWNER/DIRECTOR)
(662) 772-5937
Entity
Organization
Contact information
Practice address
8626 AIRWAYS BLVD, SOUTHAVEN, MS 38671-2603
(662) 772-5937
(662) 772-5940
Mailing address
8626 AIRWAYS BLVD, SOUTHAVEN, MS 38671-2603
(662) 772-5937
(662) 772-5940
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
2084P0800X
Psychiatry Physician
—
MS
2251P0200X
Pediatric Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
1326
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00432297
—
MS
05
—
008579847
—
MS
05
—
01128006
—
MS
05
—
01924277
—
MS
05
—
02332763
—
MS
05
—
03322249
—
MS
05
—
03350341
—
MS
05
—
03458834
—
MS
05
—
04057773
—
MS
05
—
04073099
—
MS
05
—
05103380
—
MS
05
—
05476356
—
MS
05
—
08579847
—
MS
05
—
09250853
—
MS
05
—
09485302
—
MS
05
—
09588552
—
MS
05
—
1558401521
—
MS
Enumeration date
09/01/2010
Last updated
05/01/2025
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