Healthcare Provider Details

I. General information

NPI: 1174447650
Provider Name (Legal Business Name): MAGNOLIA ROOTS BAHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6941 MAYO BLVD
NEW ORLEANS LA
70126-3054
US

IV. Provider business mailing address

6941 MAYO BLVD
NEW ORLEANS LA
70126-3054
US

V. Phone/Fax

Practice location:
  • Phone: 504-952-7346
  • Fax:
Mailing address:
  • Phone: 504-952-7346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRA AGE
Title or Position: OWNER
Credential:
Phone: 504-952-7346