Active NPI
Lisa Marie Desselles, LCSW
- Clinical Social Worker
- Jackson, MS
National Provider Identifier
1083905285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 4925
- Practice address
- 1500 E Woodrow Wilson Ave
Jackson, MS 39216-5116 - Phone
- (601) 362-4471
- NPI assigned
- Apr 22, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 4925 | LA | Primary |
Addresses
Primary practice location
1500 E Woodrow Wilson Ave
Jackson, MS 39216-5116
Mailing address
806 Carlton Park Dr
Flowood, MS 39232-5525
Phone (225) 281-5433
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4925 | LA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303430400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303430400000",
"number": "1083905285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "806 CARLTON PARK DR",
"city": "FLOWOOD",
"state": "MS",
"postal_code": "392325525",
"telephone_number": "225-281-5433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 E WOODROW WILSON AVE",
"city": "JACKSON",
"state": "MS",
"postal_code": "392165116",
"telephone_number": "601-362-4471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESSELLES",
"first_name": "LISA",
"middle_name": "MARIE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-04-22",
"last_updated": "2011-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "LA",
"license": "4925",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.