Provider Demographics
NPI:1578098406
Name:MAGNOLIA THERAPEUTIC SOLUTIONS
Entity Type:Organization
Organization Name:MAGNOLIA THERAPEUTIC SOLUTIONS
Other - Org Name:MAGNOLIA THERAPEUTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN - CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAKEITHDRA
Authorized Official - Middle Name:RASHAE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-630-2328
Mailing Address - Street 1:1630 FALCON DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2416
Mailing Address - Country:US
Mailing Address - Phone:281-630-2328
Mailing Address - Fax:
Practice Address - Street 1:1630 FALCON DR
Practice Address - Street 2:SUITE 104
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2416
Practice Address - Country:US
Practice Address - Phone:281-630-2328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty