Healthcare Provider Details

I. General information

NPI: 1922515899
Provider Name (Legal Business Name): THE MAGNOLIA INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 1/2 MASSACHUSETTS. ST. SUITE 215
LAWRENCE KS
66044
US

IV. Provider business mailing address

729 1/2 MASSACHUSETTS. ST. SUITE 215
LAWRENCE KS
66044
US

V. Phone/Fax

Practice location:
  • Phone: 785-393-4277
  • Fax:
Mailing address:
  • Phone: 785-393-4277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number3831
License Number StateKS

VIII. Authorized Official

Name: JILL A. REESE
Title or Position: THERAPIST
Credential: LSCSW
Phone: 785-393-4277