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General NPI Number Information
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NPI Number | 1437963014
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Entity Type | Organization
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Legal Business Name | MAGNOLIA MENTAL HEALTH
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 413-B MAIN STREET
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City | BANDERA
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State | TX
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Zip | 78003
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Country | US
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Telephone | 830-356-3837
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Fax |
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Provider Business Mailing Address
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Address Line | 1088 LAKEPARK DR
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City | LAKEHILLS
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State | TX
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Zip | 78063-6257
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Country | US
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Telephone | 210-485-9715
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ANDREA SEELY
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Credential | APRN
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Telephone | 830-356-3837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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