Healthcare Provider Details

I. General information

NPI: 1366245813
Provider Name (Legal Business Name): MOSAIC PSYCHOTHERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 EL CAMINO REAL # 220
MILLBRAE CA
94030-2059
US

IV. Provider business mailing address

660 EL CAMINO REAL # 220
MILLBRAE CA
94030-2059
US

V. Phone/Fax

Practice location:
  • Phone: 415-212-8790
  • Fax:
Mailing address:
  • Phone: 415-212-8790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. IAN MOSIER
Title or Position: OWNER/PRESIDENT
Credential: PHD
Phone: 415-212-8790