Provider Demographics
NPI:1285014167
Name:BAQUIE, PHILIP (LPC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:BAQUIE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 JEFFERSON AVE
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-3724
Mailing Address - Country:US
Mailing Address - Phone:662-801-9497
Mailing Address - Fax:
Practice Address - Street 1:1200 JEFFERSON AVE
Practice Address - Street 2:SUITE 200B
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-3724
Practice Address - Country:US
Practice Address - Phone:662-801-9497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional