Individual provider Active NPI

Anthony Jerome Wood, NCC, LPC-S

  • Professional Counselor
  • Southaven, MS
National Provider Identifier
1215253620
Registry record updated May 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
1326 Issued in MS
Practice address
8626 Airways Blvd
Southaven, MS 38671-2603
Phone
(662) 772-5937
Fax
(662) 772-5940
NPI assigned
Apr 9, 2010
Last updated
May 1, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 1, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Mental Health Counselor 101YM0800X 1326 MS
Professional Counselor 101YP2500X 1326 MS Primary

Addresses

Primary practice location

8626 Airways Blvd
Southaven, MS 38671-2603

Mailing address

8626 Airways Blvd
Southaven, MS 38671-2603
Phone (662) 772-5937

Other practice location 1

311 E Main St
Senatobia, MS 38668-2215
Phone (662) 772-5937

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250505002531 MS Practitioner - Mental Health Counselor 2062692494 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Desoto Familycounseling Center Current Accepting new patients
Desoto Family Counseling Center PLLC Mental Health CurrentSince May 1, 2025 Accepting new patients

Locations

311 E Main St
Senatobia, MS 38668
Phone (662) 772-5937

885 Ferncliff Cv
Ste 2
Southaven, MS 38671
Phone (662) 342-2700

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1270771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746057600000",
    "number": "1215253620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8626 AIRWAYS BLVD",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386712603",
            "telephone_number": "662-772-5937",
            "fax_number": "662-772-5940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8626 AIRWAYS BLVD",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386712603",
            "telephone_number": "662-772-5937",
            "fax_number": "662-772-5940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "311 E Main St",
            "address_purpose": "LOCATION",
            "city": "Senatobia",
            "state": "MS",
            "postal_code": "386682215",
            "country_code": "US",
            "telephone_number": "662-772-5937",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOOD",
        "first_name": "ANTHONY",
        "middle_name": "JEROME",
        "credential": "NCC, LPC-S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-04-09",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MS",
            "license": "1326",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MS",
            "license": "1326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southaven, MS

Sources for this page

Verify at the official NPI Registry.