1538505730 NPI number — CATHERINE FREY BALDWYN M.ED., NCC, LPC

Table of content: CATHERINE FREY BALDWYN M.ED., NCC, LPC (NPI 1538505730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538505730 NPI number — CATHERINE FREY BALDWYN M.ED., NCC, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALDWYN
Provider First Name:
CATHERINE
Provider Middle Name:
FREY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED., NCC, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538505730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 BOB WHITE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUPELO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38801-6152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-871-4436
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
813 VARSITY DR
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
TUPELO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38801-4703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-840-2005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: 1889 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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