Provider Demographics
NPI:1235849753
Name:MAGNOLIA AUTISM SERVICES, LLC
Entity Type:Organization
Organization Name:MAGNOLIA AUTISM SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA/LBA
Authorized Official - Phone:620-672-2228
Mailing Address - Street 1:30276 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445-3020
Mailing Address - Country:US
Mailing Address - Phone:620-672-2228
Mailing Address - Fax:
Practice Address - Street 1:30276 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445-3020
Practice Address - Country:US
Practice Address - Phone:620-672-2228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty