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Organization
MAGNOLIA MENTAL HEALTH SERVICES
Active
Organization
MAGNOLIA MENTAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONYA GREENE STELLY RN,MSM,PMHNP-BC (NURSE PRACTITIONER)
(225) 773-0942
Entity
Organization
Contact information
Practice address
11764 HAYMARKET AVE, BATON ROUGE, LA 70816-6009
(225) 773-0942
Mailing address
13170 DUTCHTOWN POINT AVE APT 1421, GONZALES, LA 70737-0105
(225) 773-0942
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316513559
—
LA
Enumeration date
05/28/2021
Last updated
09/25/2021
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