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General NPI Number Information
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NPI Number | 1902510134
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Entity Type | Organization
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Legal Business Name | MOXY UP
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Dates
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Enumeration Date | 01/11/2023
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 789 TILLMAN LN SPC C
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City | GARDNERVILLE
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State | NV
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Zip | 89460-8201
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Country | US
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Telephone | 775-790-7022
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6322
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City | GARDNERVILLE
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State | NV
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Zip | 89460-4605
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Country | US
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Telephone | 775-790-7022
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | COLEEN LAWRENCE
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Credential | MSSL, EJD
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Telephone | 775-790-7022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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