Provider Demographics
NPI:1316206519
Name:BRIX-BASKIN, TRISH ANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TRISH
Middle Name:ANNE
Last Name:BRIX-BASKIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1729
Mailing Address - Country:US
Mailing Address - Phone:601-545-8700
Mailing Address - Fax:601-288-8058
Practice Address - Street 1:36 PANTHER STADIUM DR
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-3632
Practice Address - Country:US
Practice Address - Phone:601-450-2144
Practice Address - Fax:601-450-2145
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC79231041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06955563Medicaid