Organization
MAGNOLIA COMMUNITY MENTAL HEALTH FACILITY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEWARRENT L. BRANTLEY (CEO/ PRESIDENT)
(318) 678-0907
Entity
Organization
Contact information
Practice address
2005 CRESWELL AVE, SHREVEPORT, LA 71104-2201
(318) 678-0907
(318) 678-9975
Mailing address
2005 CRESWELL AVE, P.O.BOX 4908 SHREVEPORT LA.71134, SHREVEPORT, LA 71104-2201
(318) 678-0907
(318) 678-9975
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
05/05/2006
Last updated
02/14/2008
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