Provider Demographics
NPI:1093549040
Name:MOSAIC THERAPY COLLECTIVE PLLC
Entity type:Organization
Organization Name:MOSAIC THERAPY COLLECTIVE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO; LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, HSP-P, RYT
Authorized Official - Phone:720-248-7318
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:CO
Mailing Address - Zip Code:80024-0326
Mailing Address - Country:US
Mailing Address - Phone:720-248-7318
Mailing Address - Fax:720-806-5612
Practice Address - Street 1:8096 BRIGHTON ROAD
Practice Address - Street 2:UNIT #326
Practice Address - City:DUPONT
Practice Address - State:CO
Practice Address - Zip Code:80024
Practice Address - Country:US
Practice Address - Phone:720-248-7318
Practice Address - Fax:720-806-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty