Provider Demographics
NPI:1992311542
Name:MOSAIC COUNSELING & CONSULTING, LLC
Entity type:Organization
Organization Name:MOSAIC COUNSELING & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RODRIGO
Authorized Official - Last Name:NINO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:773-307-4767
Mailing Address - Street 1:2212 MADISON PL
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1928
Mailing Address - Country:US
Mailing Address - Phone:773-307-4767
Mailing Address - Fax:847-673-4721
Practice Address - Street 1:7366 N LINCOLN AVE STE 406
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1741
Practice Address - Country:US
Practice Address - Phone:773-307-4767
Practice Address - Fax:847-673-4721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty