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General NPI Number Information
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NPI Number | 1225716178
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Entity Type | Organization
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Legal Business Name | MAGNOLIA HEALTHCARE LLC
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Dates
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Enumeration Date | 07/10/2023
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 1101 NIGHT CAP LN
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City | KNOXVILLE
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State | TN
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Zip | 37919-8746
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Country | US
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Telephone | 912-660-1547
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 NIGHT CAP LN
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City | KNOXVILLE
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State | TN
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Zip | 37919-8746
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Country | US
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Telephone | 912-660-1547
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TERA MARIE CAMPBELL
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Credential |
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Telephone | 910-849-5517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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