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NPI Code Detail

MEDICARE: MAGNOLIA MENTAL HEALTH LLC

MEDICARE: MAGNOLIA MENTAL HEALTH LLC
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
1251S00000XCommunity/Behavioral Health Agency2203783795LA

General Provider Information

NPI Number : 1851891865
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAGNOLIA MENTAL HEALTH LLC
Provider Business Mailing Address
First Line : 7629 PINES RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71129-3905
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7629 PINES RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71129-3905
Country : US
Telephone Number : 318-626-5991
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MRS. SHANELL TAYLOR
Credential : RN
Telephone Number : 318-791-7872
Provider Enumeration Date : 02/15/2018
Last Update Date : 03/29/2018

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Directions to “MAGNOLIA MENTAL HEALTH LLC ” Practice Location

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