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General NPI Number Information
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NPI Number | 1639682644
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Entity Type | Organization
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Legal Business Name | MOXIE-MH&CM SERVICES
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Dates
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Enumeration Date | 11/13/2017
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Last Update Date | 04/02/2024
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Provider Practice Location Address
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Address Line | S2941 KOUBA VALLEY RD
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City | HILLSBORO
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State | WI
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Zip | 54634-5005
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Country | US
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Telephone | 970-306-7199
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Fax | 970-829-4099
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Provider Business Mailing Address
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Address Line | PO BOX 54
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City | HILLSBORO
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State | WI
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Zip | 54634-0054
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Country | US
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Telephone | 970-306-7199
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Fax | 970-829-4099
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Authorized Official
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Title or Position | SOLE MBR/OWNER
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Name | HEATHER LOUISE BEHM
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Credential | LCSW
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Telephone | 970-306-7199
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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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