Healthcare Provider Details

I. General information

NPI: 1235781253
Provider Name (Legal Business Name): MOSAIC MIND COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 OGDEN AVE STE E
DOWNERS GROVE IL
60515-2964
US

IV. Provider business mailing address

4410 CUMNOR RD
DOWNERS GROVE IL
60515-3135
US

V. Phone/Fax

Practice location:
  • Phone: 715-617-6000
  • Fax:
Mailing address:
  • Phone: 715-617-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ARLENE ROSS LANGLEY
Title or Position: OWNER
Credential: MSW LCSW
Phone: 715-617-6000