Provider Demographics
NPI:1053994285
Name:MAGNOLIA BEHAVIOR SERVICES, LLC
Entity type:Organization
Organization Name:MAGNOLIA BEHAVIOR SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRISTIE
Authorized Official - Middle Name:SHALEIGH
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:205-919-2517
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:CHATOM
Mailing Address - State:AL
Mailing Address - Zip Code:36518-0415
Mailing Address - Country:US
Mailing Address - Phone:205-919-2517
Mailing Address - Fax:
Practice Address - Street 1:13551 SAINT STEPHENS AVE
Practice Address - Street 2:
Practice Address - City:CHATOM
Practice Address - State:AL
Practice Address - Zip Code:36518
Practice Address - Country:US
Practice Address - Phone:205-919-2517
Practice Address - Fax:251-847-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty