Provider Demographics
NPI:1912265745
Name:BAXTER, TIMOTHY G (MS, LPC, LCPC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:G
Last Name:BAXTER
Suffix:
Gender:M
Credentials:MS, LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 ELDERBANK BACKROAD
Mailing Address - Street 2:
Mailing Address - City:ELDERBANK
Mailing Address - State:NS
Mailing Address - Zip Code:B0N 1K0
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:91 ELDERBANK BACKROAD
Practice Address - Street 2:
Practice Address - City:ELDERBANK
Practice Address - State:NS
Practice Address - Zip Code:B0N 1K0
Practice Address - Country:CA
Practice Address - Phone:405-632-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OKLPC06549101YP2500X
MECC6990101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health