Healthcare Provider Details

I. General information

NPI: 1174433809
Provider Name (Legal Business Name): MAGNOLIA MENTAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 MECHE RD
RAYNE LA
70578-7846
US

IV. Provider business mailing address

2052 MECHE RD
RAYNE LA
70578-7846
US

V. Phone/Fax

Practice location:
  • Phone: 337-781-3314
  • Fax:
Mailing address:
  • Phone: 337-781-3314
  • 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: BRITANY GUIDRY
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 337-781-3314