Provider Demographics
NPI:1033936331
Name:MAGNOLIA THERAPY GROUP, LLC
Entity type:Organization
Organization Name:MAGNOLIA THERAPY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:ERNST
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:225-605-3065
Mailing Address - Street 1:2924 BRAKLEY DR STE B6
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2333
Mailing Address - Country:US
Mailing Address - Phone:225-605-3065
Mailing Address - Fax:225-605-3065
Practice Address - Street 1:2924 BRAKLEY DR STE B6
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2333
Practice Address - Country:US
Practice Address - Phone:225-605-3065
Practice Address - Fax:225-605-3065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty