Healthcare Provider Details

I. General information

NPI: 1851921985
Provider Name (Legal Business Name): MOXIE MIND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9745 E HAMPDEN AVE STE 302B
DENVER CO
80231-4940
US

IV. Provider business mailing address

9745 E HAMPDEN AVE STE 302B
DENVER CO
80231-4940
US

V. Phone/Fax

Practice location:
  • Phone: 781-689-0470
  • Fax: 720-306-5440
Mailing address:
  • Phone: 781-689-0470
  • Fax: 720-306-5440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: KARLEE GOLIGHTLY
Title or Position: OWNER, REGISTERED DIETITIAN
Credential: RD
Phone: 781-689-0470