Provider Demographics
NPI:1972652725
Name:MOXIE INCORPORATED
Entity Type:Organization
Organization Name:MOXIE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BORSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-825-3440
Mailing Address - Street 1:3001 SOUTH HENNEPIN AVENUE
Mailing Address - Street 2:B301
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2688
Mailing Address - Country:US
Mailing Address - Phone:612-825-3440
Mailing Address - Fax:612-827-2477
Practice Address - Street 1:3001 HENNEPIN AVE
Practice Address - Street 2:B301
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2647
Practice Address - Country:US
Practice Address - Phone:612-825-3440
Practice Address - Fax:612-827-2477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03756Medicare ID - Type Unspecified