Healthcare Provider Details

I. General information

NPI: 1942938634
Provider Name (Legal Business Name): MAGNOLIA COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 INTERURBAN AVE S
TUKWILA WA
98168-4723
US

IV. Provider business mailing address

PO BOX 88732
SEATTLE WA
98138-2732
US

V. Phone/Fax

Practice location:
  • Phone: 206-693-9202
  • Fax: 206-248-1160
Mailing address:
  • Phone: 206-693-9202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LANDER MITCHELL
Title or Position: DIRECTOR
Credential:
Phone: 206-693-9202