MEDICARE: MAGNOLIA PSYCHIATRIC PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	18977	MS

General Provider Information

NPI Number	:	1306031752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA PSYCHIATRIC PA

Provider Business Mailing Address
First Line	:	2124 GOVERNMENT ST
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3937
Country	:	US
Telephone Number	:	228-818-9050
Fax Number	:	228-872-6300

Provider Business Practice Location Address
First Line	:	2124 GOVERNMENT ST
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3937
Country	:	US
Telephone Number	:	228-818-9050
Fax Number	:	228-872-6300

Authorized Official
Title or Position	:	MANAGER
Name	:	MISS TRACEY L MATTINA
Credential	:
Telephone Number	:	228-818-0563

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	09/10/2007

Similar Medicare Providers

1124127618 — DR. RUTH W. MCPHEARSON PHD
Practice Location Address:

2124 GOVERNMENT ST
OCEAN SPRINGS, MS
39564-3937

Practice Phone: 228-324-3449
Practice Fax:

1235228297 — DR. ANASTASIA KELLEY MD
Practice Location Address:

2124 GOVERNMENT ST
OCEAN SPRINGS, MS
39564-3937

Practice Phone: 228-818-9050
Practice Fax: 228-872-6300

1447340161 — JESSICA ELLEN ROBERTSON M.S., LMFT
Practice Location Address:

2130 GOVERNMENT ST STE A
OCEAN SPRINGS, MS
39564-3937

Practice Phone: 228-382-3107
Practice Fax: 800-854-0906

1841595378 — MRS. ELIZABETH MACY ROGERS LPC, NCC, BCTMH
Practice Location Address:

2124 GOVERNMENT ST
OCEAN SPRINGS, MS
39564-3937

Practice Phone: 228-860-4600
Practice Fax: 888-974-3549

1952839409 — MAGNOLIA COUNSELING CENTER & SERVICES, LLC
Practice Location Address:

2130 GOVERNMENT ST STE A
OCEAN SPRINGS, MS
39564-3937

Practice Phone: 228-382-3107
Practice Fax: 800-854-0906

1487337317 — EVE GILLAN SELF MS, LPC
Practice Location Address:

2124 GOVERNMENT ST
OCEAN SPRINGS, MS
39564-3937

Practice Phone: 601-436-9514
Practice Fax:

Directions to “MAGNOLIA PSYCHIATRIC PA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.