Organization
MAGNOLIA ROOTS COLLECTIVE AND COUNSELING PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CANDACE SHULTZ LISW (OWNER)
(704) 253-0450
Entity
Organization
Contact information
Practice address
405 47TH ST, WEST DES MOINES, IA 50265-7100
(704) 253-0450
Mailing address
405 47TH ST, WEST DES MOINES, IA 50265-7100
(704) 253-0450
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861189508
—
AK
Enumeration date
06/26/2025
Last updated
06/26/2025
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