Provider Demographics
NPI:1609274893
Name:BASQUINE, ANTHONY JADEN (MHR, LPC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JADEN
Last Name:BASQUINE
Suffix:
Gender:M
Credentials:MHR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MCGEE DR STE 126
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-6705
Mailing Address - Country:US
Mailing Address - Phone:405-706-9269
Mailing Address - Fax:405-535-6269
Practice Address - Street 1:2500 MCGEE DR STE 126
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-6705
Practice Address - Country:US
Practice Address - Phone:405-706-9269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-20
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5542101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional