Provider Demographics
NPI:1275727299
Name:DESOTO FAMILY COUNSELING CENTER, PLLC
Entity Type:Organization
Organization Name:DESOTO FAMILY COUNSELING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:OUZTS
Authorized Official - Last Name:CASH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:662-342-2700
Mailing Address - Street 1:187 STATELINE RD E
Mailing Address - Street 2:SUITE 17
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-1704
Mailing Address - Country:US
Mailing Address - Phone:662-342-2700
Mailing Address - Fax:662-342-7300
Practice Address - Street 1:187 STATELINE RD E
Practice Address - Street 2:SUITE 17
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-1704
Practice Address - Country:US
Practice Address - Phone:662-342-2700
Practice Address - Fax:662-342-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-03
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0626101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty