Southern Magnolia Therapy LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

SOUTHERN MAGNOLIA THERAPY LLC

Practice address

25 N 173Rd Ave Apt 2
Goodyear, AZ 85338-6712

Phone

(864) 979-1325

NPI assigned

Mar 11, 2025

Last updated

May 5, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Ingram Malcolm Kerry Dirton, LPCNPI 1275302036

Title

Clinical Director

Phone

(864) 979-1325

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ingram Malcolm Kerry Dirton

  • Counselor
  • Phoenix, AZ
  • NPI 1275302036
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1741651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777939200000",
    "number": "1003615238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 N 173RD AVE APT 2",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853386712",
            "telephone_number": "864-979-1325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 N 173RD AVE APT 2",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853386712",
            "telephone_number": "864-979-1325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MAGNOLIA THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-11",
        "last_updated": "2026-05-05",
        "certification_date": "2026-05-05",
        "status": "A",
        "authorized_official_last_name": "DIRTON",
        "authorized_official_first_name": "INGRAM",
        "authorized_official_middle_name": "MALCOLM KERRY",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "864-979-1325",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Colleen Rose Spargur, PA-C

• Mental Health Counselor in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• Mental Health Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.