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General NPI Number Information
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NPI Number | 1053113621
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Entity Type | Organization
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Legal Business Name | MAGNOLIA BRIDGE COUNSELING, PLLC
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 5902 LAIRD DR
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City | AUSTIN
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State | TX
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Zip | 78757-3231
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Country | US
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Telephone | 609-288-0994
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 CARLOW DR
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City | AUSTIN
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State | TX
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Zip | 78745-4300
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GABRIELLE COOLIDGE
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Credential | LPC
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Telephone | 609-288-0994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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