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General NPI Number Information
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NPI Number | 1679258586
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Entity Type | Organization
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Legal Business Name | MAGNOLIA RESTORATIVE COUNSELING
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Dates
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Enumeration Date | 06/19/2023
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 1601 ELM ST STE 4360
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City | DALLAS
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State | TX
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Zip | 75201-4701
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Country | US
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Telephone | 210-904-8639
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Fax |
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Provider Business Mailing Address
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Address Line | 14317 POTRANCO RD STE. 205 #1015
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City | SAN ANTONIO
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State | TX
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Zip | 78253
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Country | US
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Telephone | 210-904-8639
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAVANNAH COFFEY
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Credential | LMFT
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Telephone | 210-904-8639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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