Healthcare Provider Details

I. General information

NPI: 1023971264
Provider Name (Legal Business Name): MOSAIC FAMILY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W EAU GALLIE BLVD STE 201J
MELBOURNE FL
32935-4149
US

IV. Provider business mailing address

1600 W EAU GALLIE BLVD STE 201J
MELBOURNE FL
32935-4149
US

V. Phone/Fax

Practice location:
  • Phone: 321-522-8415
  • Fax:
Mailing address:
  • Phone: 321-522-8415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE FARREY
Title or Position: OWNER/THERAPIST
Credential:
Phone: 321-522-8415