Provider Demographics
NPI:1578318127
Name:MAGNOLIA COUNSELING LLC
Entity Type:Organization
Organization Name:MAGNOLIA COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:256-517-3330
Mailing Address - Street 1:5 WILLIAM WAY PL SE
Mailing Address - Street 2:
Mailing Address - City:GURLEY
Mailing Address - State:AL
Mailing Address - Zip Code:35748-8032
Mailing Address - Country:US
Mailing Address - Phone:719-205-0755
Mailing Address - Fax:
Practice Address - Street 1:220 RHETT AVE SW UNIT C7
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4552
Practice Address - Country:US
Practice Address - Phone:256-517-3330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health