Healthcare Provider Details

I. General information

NPI: 1770935595
Provider Name (Legal Business Name): OXFORD COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 ENTERPRISE DR
OXFORD MS
38655
US

IV. Provider business mailing address

304 ENTERPRISE DR
OXFORD MS
38655-2762
US

V. Phone/Fax

Practice location:
  • Phone: 662-371-1711
  • Fax: 844-512-2577
Mailing address:
  • Phone: 662-371-1711
  • Fax: 662-371-1711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2006
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILIP BAQUIE
Title or Position: OWNER
Credential: PSYD LPC
Phone: 662-371-1711