Provider Demographics
NPI:1346905148
Name:MAGNOLIA THERAPY & CONSULTATION SERVICES, LLC
Entity Type:Organization
Organization Name:MAGNOLIA THERAPY & CONSULTATION SERVICES, LLC
Other - Org Name:JESSICA WINTERNHEIMER, LICSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMANIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-496-9966
Mailing Address - Street 1:4611 S 96TH ST STE 237
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1243
Mailing Address - Country:US
Mailing Address - Phone:402-496-9966
Mailing Address - Fax:402-496-9499
Practice Address - Street 1:4611 S 96TH ST STE 237
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1243
Practice Address - Country:US
Practice Address - Phone:402-496-9966
Practice Address - Fax:402-496-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-05
Last Update Date:2023-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty