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General NPI Number Information
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NPI Number | 1598412637
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Entity Type | Organization
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Legal Business Name | MAGNOLIA THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 03/08/2022
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 205 N CONCEPTION ST
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City | MOBILE
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State | AL
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Zip | 36603-6477
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Country | US
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Telephone | 251-320-5875
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Fax | 251-459-0065
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Provider Business Mailing Address
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Address Line | 205 N CONCEPTION ST
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City | MOBILE
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State | AL
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Zip | 36603-6477
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Country | US
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Telephone | 251-320-5875
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Fax | 251-459-0065
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | LAURA O GALE
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Credential | LICSW
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Telephone | 251-605-3985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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