Provider Demographics
NPI:1538505730
Name:BALDWYN, CATHERINE FREY (MED, NCC, LPC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:FREY
Last Name:BALDWYN
Suffix:
Gender:F
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 BOB WHITE DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6152
Mailing Address - Country:US
Mailing Address - Phone:662-871-4436
Mailing Address - Fax:
Practice Address - Street 1:813 VARSITY DR
Practice Address - Street 2:SUITE 5
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4703
Practice Address - Country:US
Practice Address - Phone:662-840-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MS1889101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional