Healthcare Provider Details

I. General information

NPI: 1619832300
Provider Name (Legal Business Name): MAGNOLIA RIDGE COLLABORATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3890 BEECH TREE ST
WELLINGTON CO
80549-2164
US

IV. Provider business mailing address

3890 BEECH TREE ST
WELLINGTON CO
80549-2164
US

V. Phone/Fax

Practice location:
  • Phone: 360-265-0578
  • Fax:
Mailing address:
  • Phone: 360-265-0578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MADDIE E DARNELL
Title or Position: CO-DIRECTOR
Credential: LCSW, IEMHE-E
Phone: 360-265-0578