Organization
MAGNOLIA MENTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHANELL TAYLOR RN (OWNER)
(318) 791-7872
Entity
Organization
Contact information
Practice address
7629 PINES RD, SHREVEPORT, LA 71129-3905
(318) 626-5991
Mailing address
7629 PINES RD, SHREVEPORT, LA 71129-3905
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2203783795
LA
Other
Enumeration date
02/15/2018
Last updated
03/29/2018
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