Magnolia Counseling LLC
Organization Active NPI Marriage & Family Therapist · Suffield, CT
NPI 1922435593 · NPPES record last updated Dec 16, 2023
Key facts
- NPI
- 1922435593
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 000724 (CT)
- Legal business name
- MAGNOLIA COUNSELING LLC
- Practice address
- 11 High St Ste 202
Suffield, CT 06078-2125 - Phone
- (860) 668-1444
- Fax
- (860) 668-1446
- NPI assigned
- Sep 27, 2013
- Organization subpart
- No
Authorized official
- Name
- Anna Davenport, LMFT
- Title
- Licensed Marital & Family Therapist
- Phone
- (860) 668-1444
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240228002606 | CT | Part B Supplier - Clinic/Group Practice | 8527403609 | Practice locations: Suffield, CT |
National Provider Directory
Locations
11 High St
Ste 202
Suffield, CT 06078
Phone (860) 668-1444
380 S Center St
Windsor Locks, CT 06096
Phone (860) 692-2887
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist |
106H00000X | 000724 | CT | Yes |
Addresses
Primary practice location
11 High St Ste 202
Suffield, CT 06078-2125
Mailing address
11 High St Ste 202
Suffield, CT 06078-2125
Phone (860) 668-1444
Other providers in Suffield, CT
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- Gina M Longo
- Scott Looney
- Norah M Lusignan
- Laura Anne Mafuz
- Markowski Dental Associates P C
- Carnetta Martin
- Ashley Anne Masih
- Travis M McCassey
- Curtis Daniel McCloud
All providers in Suffield, CT · Marriage & Family Therapist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 16, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.