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General NPI Number Information
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NPI Number | 1356290977
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Entity Type | Organization
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Legal Business Name | MAGNOLIA FAMILY THERAPY CENTER, INC.
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Dates
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Enumeration Date | 01/26/2026
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 3058 SAN JOSE VINEYARD CT UNIT 3
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City | SAN JOSE
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State | CA
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Zip | 95136-4982
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Country | US
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Telephone | 408-337-6868
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 18694
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City | SAN JOSE
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State | CA
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Zip | 95158-8694
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Country | US
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Telephone | 408-337-6868
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | LAUREN GM SERKIS
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Credential |
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Telephone | 808-953-5049
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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