Provider Demographics
NPI:1598412637
Name:MAGNOLIA THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:MAGNOLIA THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:O
Authorized Official - Last Name:GALE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:251-605-3985
Mailing Address - Street 1:205 N CONCEPTION ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36603-6477
Mailing Address - Country:US
Mailing Address - Phone:251-320-5875
Mailing Address - Fax:251-459-0065
Practice Address - Street 1:205 N CONCEPTION ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603-6477
Practice Address - Country:US
Practice Address - Phone:251-320-5875
Practice Address - Fax:251-459-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty