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General NPI Number Information
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NPI Number | 1275727299
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Entity Type | Organization
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Legal Business Name | DESOTO FAMILY COUNSELING CENTER, PLLC
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Dates
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Enumeration Date | 09/03/2007
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Last Update Date | 09/03/2007
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Provider Practice Location Address
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Address Line | 187 STATELINE RD E SUITE 17
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City | SOUTHAVEN
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State | MS
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Zip | 38671-1704
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Country | US
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Telephone | 662-342-2700
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Fax | 662-342-7300
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Provider Business Mailing Address
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Address Line | 187 STATELINE RD E SUITE 17
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City | SOUTHAVEN
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State | MS
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Zip | 38671-1704
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Country | US
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Telephone | 662-342-2700
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Fax | 662-342-7300
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Authorized Official
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Title or Position | CHIEF MANAGER
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Name | DR. RUTH OUZTS CASH
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Credential | PH.D
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Telephone | 662-342-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0626
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License Number State | MS
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