Provider Demographics
NPI:1962006486
Name:MOXIE FAMILY THERAPY, PC
Entity Type:Organization
Organization Name:MOXIE FAMILY THERAPY, PC
Other - Org Name:MOXIE FAMILY THERAPY, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER AND DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MELLON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:714-388-6119
Mailing Address - Street 1:17772 IRVINE BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3234
Mailing Address - Country:US
Mailing Address - Phone:714-388-6119
Mailing Address - Fax:
Practice Address - Street 1:17772 IRVINE BLVD STE 209
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3234
Practice Address - Country:US
Practice Address - Phone:714-388-6119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty