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General NPI Number Information
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NPI Number | 1316513559
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Entity Type | Organization
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Legal Business Name | MAGNOLIA MENTAL HEALTH SERVICES
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Dates
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Enumeration Date | 05/28/2021
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Last Update Date | 09/25/2021
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Provider Practice Location Address
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Address Line | 11764 HAYMARKET AVE
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City | BATON ROUGE
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State | LA
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Zip | 70816-6009
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Country | US
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Telephone | 225-773-0942
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Fax |
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Provider Business Mailing Address
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Address Line | 13170 DUTCHTOWN POINT AVE APT 1421
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City | GONZALES
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State | LA
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Zip | 70737-0105
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Country | US
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Telephone | 225-773-0942
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | TONYA GREENE STELLY
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Credential | RN,MSM,PMHNP-BC
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Telephone | 225-773-0942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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