Provider Demographics
NPI:1306663521
Name:MAGNUSON MAZZONI CENTER PLLC
Entity type:Organization
Organization Name:MAGNUSON MAZZONI CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, FOUNDER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:NORA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAGNUSON MAZZONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-407-4014
Mailing Address - Street 1:25511 BUDDE RD STE 1603
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2084
Mailing Address - Country:US
Mailing Address - Phone:281-407-4014
Mailing Address - Fax:
Practice Address - Street 1:25511 BUDDE RD STE 1603
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2084
Practice Address - Country:US
Practice Address - Phone:281-407-4014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health