Provider Demographics
NPI:1952093718
Name:MAGNOLIA RECOVERY, LLC
Entity Type:Organization
Organization Name:MAGNOLIA RECOVERY, LLC
Other - Org Name:MAGNOLIA RECOVERY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEULEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-615-9006
Mailing Address - Street 1:3605 YOUREE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2121
Mailing Address - Country:US
Mailing Address - Phone:318-615-9006
Mailing Address - Fax:
Practice Address - Street 1:3605 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2121
Practice Address - Country:US
Practice Address - Phone:318-615-9006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAGNOLIA RECOVERY , LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-22
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty