Healthcare Provider Details

I. General information

NPI: 1750122602
Provider Name (Legal Business Name): MOXIE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N HYDRAULIC ST STE 1000
WICHITA KS
67214-4246
US

IV. Provider business mailing address

140 N HYDRAULIC ST STE 1000
WICHITA KS
67214-4246
US

V. Phone/Fax

Practice location:
  • Phone: 164-444-0110
  • Fax:
Mailing address:
  • Phone: 164-444-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER DAWN CASSITY
Title or Position: OWNER
Credential: LPC
Phone: 316-708-8273