Healthcare Provider Details

I. General information

NPI: 1639682644
Provider Name (Legal Business Name): MOXIE-MH&CM SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S2941 KOUBA VALLEY RD
HILLSBORO WI
54634-5005
US

IV. Provider business mailing address

PO BOX 54
HILLSBORO WI
54634-0054
US

V. Phone/Fax

Practice location:
  • Phone: 970-306-7199
  • Fax: 970-829-4099
Mailing address:
  • Phone: 970-306-7199
  • Fax: 970-829-4099

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: HEATHER LOUISE BEHM
Title or Position: SOLE MBR/OWNER
Credential: LCSW
Phone: 970-306-7199