Wild Magnolia Wellness

LBN: Wild Magnolia Wellness
Wild Magnolia Wellness is an health care organization with primary practice located at 6501 4Th St Nw Ste H-5 , Los Ranchos NM 87107-5800. The organization recently has only one registered license in Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center), which is considered as the primary health care specialty. Wild Magnolia Wellness can be contacted via phone (505) 274-0112, or through Mckenna, Ashley Susan via phone (505) 274-0112.

Contact Information

Primary practice address
6501 4Th St Nw Ste H-5 Los Ranchos NM 87107-5800
Phone: (505) 274-0112
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Mckenna, Ashley Susan LPCC
Phone: (505) 274-0112

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) 261QM0801X 0139371 New Mexico

Profile Details

NPI number 1255820205
LBN Legal business name Wild Magnolia Wellness
DBA Doing business as
Authorized official Mckenna, Ashley Susan LPCC
Entity Organization
Organization subpart 1 No
Enumeration date May 4th, 2018
Last updated Nov 13th, 2023 - about last year

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255820205 NPPES
New Mexico MEDICAID 1730112483

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