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General NPI Number Information
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NPI Number | 1316858418
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Entity Type | Organization
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Legal Business Name | THE MAGNOLIA ABA, LLC
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Dates
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Enumeration Date | 09/16/2026
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Last Update Date | 09/16/2026
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Provider Practice Location Address
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Address Line | 2873 HIGHWAY 49 S
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City | FLORENCE
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State | MS
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Zip | 39073-9409
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Country | US
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Telephone | 601-613-2002
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 699
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City | MAGEE
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State | MS
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Zip | 39111-0699
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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 | MICHAEL BRADLEY
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Credential |
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Telephone | 601-613-2002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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