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General NPI Number Information
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NPI Number | 1124379755
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Entity Type | Organization
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Legal Business Name | MOSAIC UNLIMITED INC
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Dates
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Enumeration Date | 09/22/2012
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Last Update Date | 07/25/2018
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Provider Practice Location Address
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Address Line | 9 JUNCTION DR W SUITE 2
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City | GLEN CARBON
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State | IL
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Zip | 62034
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Country | US
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Telephone | 618-407-0900
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Fax | 618-205-3275
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Provider Business Mailing Address
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Address Line | 9 JUNCTION DR W STE 5
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City | GLEN CARBON
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State | IL
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Zip | 62034-2931
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Country | US
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Telephone | 618-407-0900
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | RENEE KELLER
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Credential |
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Telephone | 618-407-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149015007
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License Number State | IL
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