Provider Demographics
NPI:1740857234
Name:MAGNOLIA COUNSELING
Entity type:Organization
Organization Name:MAGNOLIA COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:651-504-2483
Mailing Address - Street 1:710 N MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-3605
Mailing Address - Country:US
Mailing Address - Phone:651-504-2483
Mailing Address - Fax:
Practice Address - Street 1:710 N MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-3605
Practice Address - Country:US
Practice Address - Phone:651-504-2483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-04
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service