Provider Demographics
NPI:1396477824
Name:MAGNOLIA WAY COUNSELING AND ASSESSMENTS, LLC
Entity type:Organization
Organization Name:MAGNOLIA WAY COUNSELING AND ASSESSMENTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:501-438-1515
Mailing Address - Street 1:PO BOX 783
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-0783
Mailing Address - Country:US
Mailing Address - Phone:501-575-0510
Mailing Address - Fax:501-575-0550
Practice Address - Street 1:287 S BROADVIEW ST STE C-2
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9233
Practice Address - Country:US
Practice Address - Phone:501-575-0510
Practice Address - Fax:501-575-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty