Healthcare Provider Details

I. General information

NPI: 1033897715
Provider Name (Legal Business Name): MOXIE PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 ANN ARBOR SALINE RD APT 103
ANN ARBOR MI
48103-9865
US

IV. Provider business mailing address

3290 ANN ARBOR SALINE RD APT 103
ANN ARBOR MI
48103-9865
US

V. Phone/Fax

Practice location:
  • Phone: 734-926-9452
  • Fax:
Mailing address:
  • Phone: 734-926-9452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JAMIE BOSCHEE
Title or Position: CLINICAL SOCIAL WORKER
Credential: LMSW
Phone: 734-926-9452