Healthcare Provider Details

I. General information

NPI: 1962990465
Provider Name (Legal Business Name): THE WELLNESS CENTER OF OXFORD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 ENTERPRISE DR
OXFORD MS
38655-2762
US

IV. Provider business mailing address

304 ENTERPRISE DR
OXFORD MS
38655-2762
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

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