Organization
MAGNOLIA AUTISM THERAPY
Active
Organization
MAGNOLIA AUTISM THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MCCULLOUGH CAMPBELL (CONTACT PERSON)
(206) 453-4882
Entity
Organization
Contact information
Practice address
3214 W MCGRAW ST, STE 212, SEATTLE, WA 98199-3239
(206) 453-4882
Mailing address
3214 W MCGRAW ST, STE 212, SEATTLE, WA 98199-3239
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
CG60506476
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG60506476
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
Enumeration date
02/21/2015
Last updated
02/21/2015
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