Healthcare Provider Details

I. General information

NPI: 1285218776
Provider Name (Legal Business Name): MOXIE MUSIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4804 HILLSPRING CIR UNIT B
AUSTIN TX
78721-1605
US

IV. Provider business mailing address

4804 HILLSPRING CIR UNIT B
AUSTIN TX
78721-1605
US

V. Phone/Fax

Practice location:
  • Phone: 512-914-0339
  • Fax:
Mailing address:
  • Phone: 512-914-0339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANNE VANDERVOORT
Title or Position: MUSIC THERAPIST/OWNER
Credential: MM, MT-BC
Phone: 512-914-0339