Healthcare Provider Details

I. General information

NPI: 1083401848
Provider Name (Legal Business Name): MOXIE MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3049 GALVESTON ST
PLANO TX
75075-0028
US

IV. Provider business mailing address

3049 GALVESTON ST
PLANO TX
75075-0028
US

V. Phone/Fax

Practice location:
  • Phone: 817-966-8111
  • Fax:
Mailing address:
  • Phone: 817-966-8111
  • 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: SAMANTHA WHITE
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 817-966-8111