Provider Demographics
NPI:1124627484
Name:MOSAIC COUNSELING INC
Entity type:Organization
Organization Name:MOSAIC COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JIT
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:937-244-9209
Mailing Address - Street 1:2948 SUMMER POINT CT
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-4023
Mailing Address - Country:US
Mailing Address - Phone:937-244-9209
Mailing Address - Fax:270-297-4944
Practice Address - Street 1:2767 VEACH RD STE D
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6200
Practice Address - Country:US
Practice Address - Phone:270-385-0096
Practice Address - Fax:270-297-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty