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Organization
MAGNOLIA MENTAL HEALTH CLINIC PLLC
Active
Organization
MAGNOLIA MENTAL HEALTH CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALISHA MCCOOL PMHNP (OWNER/PMHNP)
(501) 209-3362
Entity
Organization
Contact information
Practice address
1061 FRONT ST, CONWAY, AR 72032-4305
(501) 209-3362
Mailing address
1061 FRONT ST, CONWAY, AR 72032-4305
(501) 209-3362
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1366033749
NPI
AR
Enumeration date
11/07/2023
Last updated
08/22/2024
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