Provider Demographics
NPI:1609551787
Name:MOXIE NOVA
Entity Type:Organization
Organization Name:MOXIE NOVA
Other - Org Name:MOXIE NOVA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:JADE
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-340-7323
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-0308
Mailing Address - Country:US
Mailing Address - Phone:712-340-7323
Mailing Address - Fax:712-560-9088
Practice Address - Street 1:1820 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334-2409
Practice Address - Country:US
Practice Address - Phone:712-340-7323
Practice Address - Fax:712-560-9088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-16
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty