Healthcare Provider Details

I. General information

NPI: 1447198148
Provider Name (Legal Business Name): SOPHIA TERESA BAKKER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 UNION AVE
MEMPHIS TN
38104-4205
US

IV. Provider business mailing address

14245 MILLER STATION LN
OLIVE BRANCH MS
38654-6338
US

V. Phone/Fax

Practice location:
  • Phone: 901-545-9083
  • Fax:
Mailing address:
  • Phone: 901-545-9083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7127
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: