Healthcare Provider Details

I. General information

NPI: 1962901249
Provider Name (Legal Business Name): MOSAIC COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 04/03/2022
Certification Date: 04/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10295 E 59TH AVE
DENVER CO
80238-4143
US

IV. Provider business mailing address

10295 E 59TH AVE
DENVER CO
80238-4143
US

V. Phone/Fax

Practice location:
  • Phone: 310-429-5346
  • Fax:
Mailing address:
  • Phone: 303-909-3427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number89586
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE IVES
Title or Position: PRESIDENT
Credential: LMFT
Phone: 310-429-5346