Organization
THE MAGNOLIA CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB WASONGA (OWNER)
(817) 609-2289
Entity
Organization
Contact information
Practice address
1124 GALVESTON AVE STE B, FORT WORTH, TX 76104-4878
(817) 609-2289
Mailing address
PO BOX 592732, SAN ANTONIO, TX 78259-0186
(817) 609-2289
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
10/19/2021
Last updated
10/19/2021
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