MEDICARE: SOUTHERN MAGNOLIA THERAPEUTIC SOLUTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101Y00000X	Counselor
3	104100000X	Social Worker
4	172V00000X	Community Health Worker
5	251S00000X	Community/Behavioral Health Agency
6	1041C0700X	Clinical Social Worker
7	101YP2500X	Professional Counselor
8	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1184484032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN MAGNOLIA THERAPEUTIC SOLUTIONS

Provider Business Mailing Address
First Line	:	PO BOX 763773
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75376-3773
Country	:	US
Telephone Number	:	214-289-0456
Fax Number	:

Provider Business Practice Location Address
First Line	:	4347 S HAMPTON RD # 243
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232-1065
Country	:	US
Telephone Number	:	214-289-0456
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHEF EXECTIVE OFFICER
Name	:	KENDRA WILLIAMS
Credential	:	BSW
Telephone Number	:	214-289-0456

Provider Enumeration Date	:	03/19/2024
Last Update Date	:	02/26/2026

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