Provider Demographics
NPI:1093549958
Name:MAGNOLIA BLOOM BEHAVIOR SOLUTIONS
Entity type:Organization
Organization Name:MAGNOLIA BLOOM BEHAVIOR SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE OWNING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BUEHRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-993-3829
Mailing Address - Street 1:823 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-1214
Mailing Address - Country:US
Mailing Address - Phone:706-993-3829
Mailing Address - Fax:706-955-1048
Practice Address - Street 1:823 BROAD ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1214
Practice Address - Country:US
Practice Address - Phone:706-993-3829
Practice Address - Fax:706-955-1048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-31
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty