Wild Magnolia Wellness
NPI #1255820205 in Los Ranchos, New Mexico
Provider Information
- NPI Number
- 1255820205
- Entity Type
- Organization
- Organization Name
- Wild Magnolia Wellness
- Primary Specialty
- Clinic/Center - Mental Health (Including Community Mental Health Center)
- Enumeration Date
- May 4, 2018
- Last Updated
- Nov 13, 2023
Practice Location
- Address
- 6501 4TH ST NW STE H-5
- City
- Los Ranchos
- State
- New Mexico
- ZIP Code
- 87107-5800
- Phone
- (505) 274-0112
Authorized Official
- Name
- ASHLEY SUSAN MCKENNA, LPCC
- Title
- OWNER
- Phone
- (505) 274-0112
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center) |
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