NPIMap

Organization Active NPI

Wild Magnolia Wellness

  • Community/Behavioral Health Agency
  • Los Ranchos, NM
National Provider Identifier
1255820205
Registry record updated Jul 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
0139371 Issued in NM
Legal business name
WILD MAGNOLIA WELLNESS
Practice address
6501 4TH St NW Ste H-5
Los Ranchos, NM 87107-5800
Phone
(505) 274-0112
NPI assigned
May 4, 2018
Last updated
Jul 1, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2026

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

Authorized official

Name
Ashley Susan McKenna, LPCCNPI 1326295056
Title
Owner
Phone
(505) 274-0112

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 0139371 NM Primary

Addresses

Primary practice location

6501 4TH St NW Ste H-5
Los Ranchos, NM 87107-5800

Mailing address

4304 Carlisle Blvd NE
Albuquerque, NM 87107-4811
Phone (505) 274-0112

Other practice location 1

4304 Carlisle Blvd NE
Albuquerque, NM 87107-4811
Phone (505) 433-7561

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210121001173 NM Part B Supplier - Clinic/Group Practice 8729492491 Receives reassigned benefits from 7 practitioners
Practice locations: Los Ranchos, NM; Albuquerque, NM

National Provider Directory

National Provider Directory

Locations

4304 Carlisle Blvd NE
Albuquerque, NM 87107
Phone (505) 433-7561

6501 4th St NW
Ste H5
Los Ranchos, NM 87107
Phone (505) 274-0112

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1525392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782864000000",
    "number": "1255820205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4304 CARLISLE BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871074811",
            "telephone_number": "505-274-0112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6501 4TH ST NW STE H-5",
            "city": "LOS RANCHOS",
            "state": "NM",
            "postal_code": "871075800",
            "telephone_number": "505-274-0112"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4304 Carlisle Blvd NE",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871074811",
            "country_code": "US",
            "telephone_number": "505-433-7561",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WILD MAGNOLIA WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-04",
        "last_updated": "2026-07-01",
        "certification_date": "2026-07-01",
        "status": "A",
        "authorized_official_last_name": "MCKENNA",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_middle_name": "SUSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-274-0112",
        "authorized_official_credential": "LPCC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NM",
            "license": "0139371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Ranchos, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.