Healthcare Provider Details

I. General information

NPI: 1922808237
Provider Name (Legal Business Name): MOSAIC COUNSELING COLLABORATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 NEW ST
PITTSTON PA
18640-2123
US

IV. Provider business mailing address

103 NEW ST
PITTSTON PA
18640-2123
US

V. Phone/Fax

Practice location:
  • Phone: 570-536-0510
  • Fax:
Mailing address:
  • Phone: 570-536-0510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TARA LYN AHEARN SIMINGTON
Title or Position: CO-OWNER
Credential: LPC
Phone: 570-536-0510