Healthcare Provider Details

I. General information

NPI: 1356234884
Provider Name (Legal Business Name): ECLECTIC-MOSAIC WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 OVERLOOK DR
PALMER MA
01069-9316
US

IV. Provider business mailing address

1100 OVERLOOK DR
PALMER MA
01069-9316
US

V. Phone/Fax

Practice location:
  • Phone: 401-484-1616
  • Fax:
Mailing address:
  • Phone: 413-544-1737
  • Fax: 413-487-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHAVON LATOIYA MEYERS
Title or Position: OWNER
Credential: LMHC, LPC, NCC
Phone: 413-544-1737