Provider Demographics
NPI:1639682644
Name:MOXIE-MH&CM SERVICES
Entity Type:Organization
Organization Name:MOXIE-MH&CM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BEHM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:970-306-7199
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:WI
Mailing Address - Zip Code:54634-0054
Mailing Address - Country:US
Mailing Address - Phone:970-306-7199
Mailing Address - Fax:970-829-4099
Practice Address - Street 1:S2941 KOUBA VALLEY RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:WI
Practice Address - Zip Code:54634-5005
Practice Address - Country:US
Practice Address - Phone:970-306-7199
Practice Address - Fax:970-829-4099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty