Provider Demographics
NPI:1124274584
Name:MOSAIC COUNSELING SERVICES
Entity type:Organization
Organization Name:MOSAIC COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:717-540-8041
Mailing Address - Street 1:13 N PROGRESS AVE
Mailing Address - Street 2:#216
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-3547
Mailing Address - Country:US
Mailing Address - Phone:717-540-8041
Mailing Address - Fax:717-540-8096
Practice Address - Street 1:13 N PROGRESS AVE
Practice Address - Street 2:#216
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-3547
Practice Address - Country:US
Practice Address - Phone:717-540-8041
Practice Address - Fax:717-540-8096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW012788251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health