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General NPI Number Information
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NPI Number | 1033083662
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Entity Type | Organization
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Legal Business Name | MAGNOLIA THERAPY CENTER LLC
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 11/15/2025
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Provider Practice Location Address
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Address Line | 300 SW 107TH AVE STE 205
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City | MIAMI
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State | FL
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Zip | 33174-3602
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Country | US
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Telephone | 305-209-0038
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Fax | 305-675-7767
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Provider Business Mailing Address
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Address Line | 300 SW 107TH AVE STE 205
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City | MIAMI
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State | FL
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Zip | 33174-3602
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Country | US
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Telephone | 305-209-0038
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Fax | 305-675-7767
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Authorized Official
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Title or Position | AMBR
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Name | MRS. LILIANA GALVEZ ALONSO
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Credential |
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Telephone | 305-209-0038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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