# MAGNOLIA MENTAL HEALTH CLINIC PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1972376309
- **Authorized official:** ALISHA MCCOOL PMHNP (OWNER/PMHNP)
- **Authorized official phone:** (501) 209-3362

## Contact information

- **Practice address:** 1061 FRONT ST, CONWAY, AR 72032-4305
- **Practice address phone:** (501) 209-3362
- **Mailing address:** 1061 FRONT ST, CONWAY, AR 72032-4305
- **Mailing address phone:** (501) 209-3362

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/07/2023
- **Last updated:** 08/22/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1366033749 | NPI | AR |