| Southern Magnolia Therapy Llc | |
|
708 S Lindon Ln Apt 5020a Tempe AZ 85281 | |
| (864) 979-1325 | |
| Not Available |
| Full Name | Southern Magnolia Therapy Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 708 S Lindon Ln, Tempe, Arizona |
| Authorized Official Name and Position | Ingram Malcolm Kerry Dirton (CLINICAL DIRECTOR) |
| Authorized Official Contact | 8649791325 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Magnolia Therapy Llc 708 S Lindon Ln Apt 5020a Tempe AZ 85281 Ph: (864) 979-1325 | Southern Magnolia Therapy Llc 708 S Lindon Ln Apt 5020a Tempe AZ 85281 Ph: (864) 979-1325 |
| NPI Number | 1003615238 |
|---|---|
| Provider Enumeration Date | 03/11/2025 |
| Last Update Date | 03/11/2025 |
| Certification Date | 03/11/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003615238 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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