Organization Name: | DESOTO FAMILY COUNSELING CENTER PLLC |
NPI Number: | 1912214792 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANTHONY JEROME WOOD (OWNER) |
Mailing Address: | 6858 Swinnea Rd, Bldg 4 Southaven |
State: | MS US |
Postal Code: | 386719493 |
Phone Number: | 6627725937 |
Fax Number: | 6627725940 |
NPI Enumeration Date: | 09/01/2010 |
NPI Last Update Date: | 06/07/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |