Desoto Family Counseling Center PLLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

1326 Issued in MS

Legal business name

DESOTO FAMILY COUNSELING CENTER PLLC

Practice address

8626 Airways Blvd
Southaven, MS 38671-2603

Phone

(662) 772-5937

Fax

(662) 772-5940

NPI assigned

Sep 1, 2010

Last updated

May 1, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Anthony Jerome Wood, LPC-SNPI 1215253620

Title

Owner/Director

Phone

(662) 772-5937

Specialties & licenses 7

Addresses

Other identifiers 17

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 47

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Wendy A Dagley, PLPC

  • Professional Counselor
  • Southaven, MS
  • NPI 1578211447
  Medicare reassignment Care Compare group NPD
• Casey Rae De Vito, LPC

  • Professional Counselor
  • Southaven, MS
  • NPI 1396549697
  Medicare reassignment Care Compare group NPD
• Denise F Fowler, LCSW

  • Clinical Social Worker
  • Southaven, MS
  • NPI 1326125931
  Medicare reassignment Care Compare group NPD
• Madison Makenzie Gooch, DNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Southaven, MS
  • NPI 1437978103
  Medicare reassignment Care Compare group NPD
• Madeline Marie Gray, LMSW

  • Clinical Social Worker
  • Southaven, MS
  • NPI 1649005265
  Medicare reassignment Care Compare group NPD
• Tracey Mitchell, M.ED., NCC

  • Professional Counselor
  • Southaven, MS
  • NPI 1417310475

  Mental Health

  Medicare reassignment Care Compare group NPD
• Alison Edge Smith, MSN, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Southaven, MS
  • NPI 1528883667
  Medicare reassignment Care Compare group NPD
• Marilyn S Snow, PH.D. ,LPC

  • Professional Counselor
  • Southaven, MS
  • NPI 1003917535
  Medicare reassignment Care Compare group NPD
• Margaret Ann Wallace, LCSW

  • Clinical Social Worker
  • Southaven, MS
  • NPI 1700110764
  Medicare reassignment Care Compare group NPD
• Jeanie Warren, LCSW

  • Clinical Social Worker
  • Southaven, MS
  • NPI 1225286230
  Medicare reassignment Care Compare group NPD
• Anthony Jerome Wood, NCC, LPC-S

  • Professional Counselor
  • Southaven, MS
  • NPI 1215253620

  Mental Health

  Medicare reassignment NPD Authorized official
• Tia Beasley, PA-C

  • Physician Assistant
  • Tupelo, MS
  • NPI 1336504778
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1283299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746057600000",
    "number": "1912214792",
    "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": {
        "organization_name": "DESOTO FAMILY COUNSELING CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-01",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "JEROME",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "662-772-5937",
        "authorized_official_credential": "LPC-S"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MS",
            "license": null,
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MS",
            "license": "1326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04057773",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09485302",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08579847",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09250853",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1558401521",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03322249",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008579847",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03350341",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05476356",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02332763",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05103380",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09588552",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00432297",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01128006",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01924277",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03458834",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04073099",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "officemgr@desotofamilycounseling.org",
            "affiliation": "N",
            "endpointDescription": "Credentialing Contact",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Main Location",
            "address_1": "8626 Airways Blvd",
            "city": "Southaven",
            "state": "MS",
            "country_code": "US",
            "postal_code": "386712603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Desoto Dna and Diagnostic Center
• Desoto Eye and Ear
• Desoto Eye Surgery Center LLC
• Desoto Eyecare Inc
• Desoto Family Care Clinic, PLLC
• Desoto Family Counseling Center, PLLC
• Desoto Family Medical Center
• Desoto Family Vision PLLC
• Desoto Family Wellness Center, LLC
• Desoto Familycounseling Center

• Community/Behavioral Health Agency in Southaven, MS
• Providers in Southaven, MS by specialty
• Community/Behavioral Health Agency in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.