Healthcare Provider Details

I. General information

NPI: 1366254484
Provider Name (Legal Business Name): MOSAIC MINDS MENTAL HEALTH COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 COLE ST
CUMMINGTON MA
01026
US

IV. Provider business mailing address

PO BOX 164
CUMMINGTON MA
01026-0164
US

V. Phone/Fax

Practice location:
  • Phone: 413-588-1438
  • Fax:
Mailing address:
  • Phone: 413-588-1438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SUSAN TEASLEY
Title or Position: OWNER
Credential:
Phone: 413-588-1438