Healthcare Provider Details

I. General information

NPI: 1083187058
Provider Name (Legal Business Name): MOSAIC COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11516 N PORT WASHINGTON RD STE 208
MEQUON WI
53092-3441
US

IV. Provider business mailing address

11516 N PORT WASHINGTON RD STE 208
MEQUON WI
53092-3441
US

V. Phone/Fax

Practice location:
  • Phone: 262-229-5573
  • Fax: 262-292-5563
Mailing address:
  • Phone: 262-229-5573
  • Fax: 262-292-5563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANN MARIE ARVOY
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LPC
Phone: 262-229-5573