Provider Demographics
NPI:1750686184
Name:MOKSA YOGA THERAPY, LLC
Entity Type:Organization
Organization Name:MOKSA YOGA THERAPY, LLC
Other - Org Name:FOX COUNSELING & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:986-688-0208
Mailing Address - Street 1:29696 SPOON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-4437
Mailing Address - Country:US
Mailing Address - Phone:985-688-0208
Mailing Address - Fax:866-656-1713
Practice Address - Street 1:2265 LIVERNOIS RD STE 260
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1639
Practice Address - Country:US
Practice Address - Phone:985-688-0208
Practice Address - Fax:866-656-1713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-15
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010831851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI83314Medicaid