Provider Demographics
NPI:1710468863
Name:WELLNESS & COUNSELING CENTER OF TUPELO LLC
Entity Type:Organization
Organization Name:WELLNESS & COUNSELING CENTER OF TUPELO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAQUIE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:183-329-2935
Mailing Address - Street 1:304 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-2762
Mailing Address - Country:US
Mailing Address - Phone:662-371-1711
Mailing Address - Fax:
Practice Address - Street 1:499 GLOSTER CREEK VLG STE F-5C
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4600
Practice Address - Country:US
Practice Address - Phone:833-292-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty