Provider Demographics
NPI:1962990465
Name:THE WELLNESS CENTER OF OXFORD LLC
Entity type:Organization
Organization Name:THE WELLNESS CENTER OF OXFORD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:BAQUIE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LPC
Authorized Official - Phone:662-371-1711
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:662-371-1711
Practice Address - Street 1:304 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-2762
Practice Address - Country:US
Practice Address - Phone:662-371-1711
Practice Address - Fax:662-371-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)