Provider Demographics
NPI:1184484032
Name:SOUTHERN MAGNOLIA THERAPEUTIC SOLUTIONS
Entity type:Organization
Organization Name:SOUTHERN MAGNOLIA THERAPEUTIC SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHEF EXECTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:214-289-0456
Mailing Address - Street 1:PO BOX 763773
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75376-3773
Mailing Address - Country:US
Mailing Address - Phone:214-289-0456
Mailing Address - Fax:
Practice Address - Street 1:4347 S HAMPTON RD # 243
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-1065
Practice Address - Country:US
Practice Address - Phone:214-289-0456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty