Healthcare Provider Details

I. General information

NPI: 1932037843
Provider Name (Legal Business Name): MAGNOLIA PSYCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 ALFRED ST
SCOTT LA
70583-5117
US

IV. Provider business mailing address

913 ALFRED ST
SCOTT LA
70583-5117
US

V. Phone/Fax

Practice location:
  • Phone: 337-231-8787
  • Fax: 337-231-8789
Mailing address:
  • Phone: 337-231-8787
  • 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: MS. BLAIR NICOLE RACHAL
Title or Position: OWNER/ PMHNP-BC
Credential: APRN
Phone: 337-231-8787