Provider Demographics
NPI:1437880994
Name:MAGNOLIA COMMUNITY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:MAGNOLIA COMMUNITY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUNAMYS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRALLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-450-1052
Mailing Address - Street 1:2513 W HILLSBOROUGH AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-6122
Mailing Address - Country:US
Mailing Address - Phone:813-450-1052
Mailing Address - Fax:
Practice Address - Street 1:2513 W HILLSBOROUGH AVE STE 210
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-6122
Practice Address - Country:US
Practice Address - Phone:813-443-5530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty