Healthcare Provider Details

I. General information

NPI: 1598578510
Provider Name (Legal Business Name): MARI MOXLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 N CEDAR ST
COLORADO SPRINGS CO
80903-2720
US

IV. Provider business mailing address

928 N CEDAR ST
COLORADO SPRINGS CO
80903-2720
US

V. Phone/Fax

Practice location:
  • Phone: 901-870-7613
  • Fax:
Mailing address:
  • Phone: 901-870-7613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09931261
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: