Active NPI
Benjamin Wood, SWMFT
- Marriage & Family Therapist
- Gulfport, MS
National Provider Identifier
1649832999
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- T0513
- Practice address
- 12337 Ashley Dr Ste C
Gulfport, MS 39503-2753 - Phone
- (601) 366-0722
- Fax
- (601) 336-0968
- NPI assigned
- Jul 7, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | T0513 | MS | Primary |
Addresses
Primary practice location
12337 Ashley Dr Ste C
Gulfport, MS 39503-2753
Mailing address
20329 Gordon St
Saucier, MS 39574-6070
Phone (601) 366-0722
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 5, 2024 through Jan 5, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T0513 | MS | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572480000000",
"number": "1649832999",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20329 GORDON ST",
"city": "SAUCIER",
"state": "MS",
"postal_code": "395746070",
"telephone_number": "601-366-0722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12337 ASHLEY DR STE C",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395032753",
"telephone_number": "601-366-0722",
"fax_number": "601-336-0968"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOOD",
"first_name": "BENJAMIN",
"credential": "SWMFT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-07",
"last_updated": "2019-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MS",
"license": "T0513",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gulfport, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.