MEDICARE: MAGNOLIA COUNSELING

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1740857234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA COUNSELING

Provider Business Mailing Address
First Line	:	710 N MAIN ST STE 204
Second Line	:
City	:	RIVER FALLS
State	:	WI
Zip	:	54022-3605
Country	:	US
Telephone Number	:	651-504-2483
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 N MAIN ST STE 204
Second Line	:
City	:	RIVER FALLS
State	:	WI
Zip	:	54022-3605
Country	:	US
Telephone Number	:	651-504-2483
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAURA HODGES
Credential	:	LMFT
Telephone Number	:	651-504-2483

Provider Enumeration Date	:	06/04/2021
Last Update Date	:	08/06/2023

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