Magnolia Community Mental Health Facility Inc.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

MAGNOLIA COMMUNITY MENTAL HEALTH FACILITY INC.

Practice address

2005 Creswell Ave
Shreveport, LA 71104-2201

Phone

(318) 678-0907

Fax

(318) 678-9975

NPI assigned

May 5, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Dewarrent L. Brantley

Title

Ceo/ President

Phone

(318) 678-0907

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202947200000",
    "number": "1982652301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 CRESWELL AVE",
            "address_2": "P.O.BOX 4908 SHREVEPORT LA.71134",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711042201",
            "telephone_number": "318-678-0907",
            "fax_number": "318-678-9975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 CRESWELL AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711042201",
            "telephone_number": "318-678-0907",
            "fax_number": "318-678-9975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA COMMUNITY MENTAL HEALTH FACILITY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2008-02-14",
        "status": "A",
        "authorized_official_last_name": "BRANTLEY",
        "authorized_official_first_name": "DEWARRENT",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO/ PRESIDENT",
        "authorized_official_telephone_number": "318-678-0907",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Decker Magee, M.C.D., CCC-A
• Jason L Maggio, D.C.
• Rebecca Prince Maggio, LOTR
• Christopher Micheal Magill, PA-C
• Nan Magness, LPC
• Magnolia Comprehensive Outpatient Rehabiliation Facility Inc.
• Magnolia Diagnostic Services Inc.
• Magnolia Diagonstic Services Inc.
• Magnolia Durable Medical Equipment Inc.
• Magnolia Family Support & Interventions, LLC

• Mental Health Clinic/Center (Including Community Mental Health Center) in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2008; 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.