Provider Demographics
NPI:1679258586
Name:MAGNOLIA RESTORATIVE COUNSELING
Entity Type:Organization
Organization Name:MAGNOLIA RESTORATIVE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAVANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:210-904-8639
Mailing Address - Street 1:14317 POTRANCO RD
Mailing Address - Street 2:STE. 205 #1015
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253
Mailing Address - Country:US
Mailing Address - Phone:210-904-8639
Mailing Address - Fax:
Practice Address - Street 1:1601 ELM ST STE 4360
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-4701
Practice Address - Country:US
Practice Address - Phone:210-904-8639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty