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General NPI Number Information
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NPI Number | 1124627484
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Entity Type | Organization
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Legal Business Name | MOSAIC COUNSELING INC
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Dates
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Enumeration Date | 10/19/2020
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Last Update Date | 10/19/2020
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Provider Practice Location Address
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Address Line | 2767 VEACH RD STE D
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City | OWENSBORO
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State | KY
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Zip | 42303-6200
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Country | US
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Telephone | 270-385-0096
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Fax | 270-297-4944
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Provider Business Mailing Address
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Address Line | 2948 SUMMER POINT CT
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City | OWENSBORO
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State | KY
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Zip | 42303-4023
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Country | US
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Telephone | 937-244-9209
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Fax | 270-297-4944
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMIE JIT
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Credential | LPCC
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Telephone | 937-244-9209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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