Healthcare Provider Details

I. General information

NPI: 1326903998
Provider Name (Legal Business Name): MAGNOLIA CHILD AND FAMILY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24093 GRAFTON AVE
MURRIETA CA
92562-5317
US

IV. Provider business mailing address

24093 GRAFTON AVE
MURRIETA CA
92562-5317
US

V. Phone/Fax

Practice location:
  • Phone: 765-367-4340
  • Fax:
Mailing address:
  • Phone: 765-367-4340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHELBY RUSK
Title or Position: OWNER
Credential: LCSW
Phone: 765-376-2523