Healthcare Provider Details

I. General information

NPI: 1326646944
Provider Name (Legal Business Name): MOSAIC COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 CARLISLE BLVD NE STE A
ALBUQUERQUE NM
87110-4971
US

IV. Provider business mailing address

4804 OVERLAND ST NE
ALBUQUERQUE NM
87109-2667
US

V. Phone/Fax

Practice location:
  • Phone: 505-750-4243
  • Fax:
Mailing address:
  • Phone: 505-750-4243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JULIE K GRAY
Title or Position: OWNER
Credential: LCSW
Phone: 505-720-3781