Provider Demographics
NPI:1033473905
Name:MAGNOLIA INSTRUCTIONAL CENTER
Entity Type:Organization
Organization Name:MAGNOLIA INSTRUCTIONAL CENTER
Other - Org Name:THE MAGNOLIA SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:HOUSEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:281-731-6325
Mailing Address - Street 1:2903 RR 620 N BLDG B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-2208
Mailing Address - Country:US
Mailing Address - Phone:512-266-9620
Mailing Address - Fax:512-284-8122
Practice Address - Street 1:2903 RR 620 N BLDG B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734
Practice Address - Country:US
Practice Address - Phone:512-266-9620
Practice Address - Fax:512-284-8122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty