# MAGNOLIA'S HEART INCORPORATED LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720423023
- **Authorized official:** LISA MOFFETT LCSW (CEO)
- **Authorized official phone:** (702) 201-1657

## Contact information

- **Practice address:** 4550 W OAKEY BLVD STE 111M, LAS VEGAS, NV 89102-1581
- **Practice address phone:** (702) 201-1657
- **Practice address fax:** (702) 921-3333
- **Mailing address:** PO BOX 46212, LAS VEGAS, NV 89114-6212
- **Mailing address phone:** (702) 201-1657
- **Mailing address fax:** (702) 921-3333

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 05/01/2013
- **Last updated:** 04/19/2020