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General NPI Number Information
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NPI Number | 1609551787
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Entity Type | Organization
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Legal Business Name | MOXIE NOVA
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Dates
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Enumeration Date | 06/16/2023
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 1820 CENTRAL AVE
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City | ESTHERVILLE
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State | IA
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Zip | 51334-2409
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Country | US
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Telephone | 712-340-7323
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Fax | 712-560-9088
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Provider Business Mailing Address
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Address Line | PO BOX 308
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City | ESTHERVILLE
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State | IA
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Zip | 51334-0308
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Country | US
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Telephone | 712-340-7323
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Fax | 712-560-9088
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Authorized Official
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Title or Position | OWNER & CEO
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Name | AMANDA JADE OLSON
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Credential |
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Telephone | 712-340-7323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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