Provider Demographics
NPI:1851921985
Name:MOXIE MIND
Entity Type:Organization
Organization Name:MOXIE MIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:KARLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLIGHTLY
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:781-689-0470
Mailing Address - Street 1:9745 E HAMPDEN AVE STE 302B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4940
Mailing Address - Country:US
Mailing Address - Phone:781-689-0470
Mailing Address - Fax:720-306-5440
Practice Address - Street 1:9745 E HAMPDEN AVE STE 302B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4940
Practice Address - Country:US
Practice Address - Phone:781-689-0470
Practice Address - Fax:720-306-5440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty