Organization
MAGNOLIA BEHAVIORAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEGAN MUSSO (MANAGER)
(337) 912-9006
Entity
Organization
Contact information
Practice address
3501 5TH AVE STE C1, LAKE CHARLES, LA 70607-2155
(337) 419-0086
Mailing address
1100 HENRIETTA LN, LAKE CHARLES, LA 70605-1415
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
03/09/2023
Last updated
03/09/2023
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