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General NPI Number Information
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NPI Number | 1265248215
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Entity Type | Organization
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Legal Business Name | MINDFUL MOSAIC THERAPY PC
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 6777 CAMP BOWIE BLVD STE 324
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City | FORT WORTH
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State | TX
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Zip | 76116-7178
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Country | US
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Telephone | 817-739-7428
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1266
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City | WEATHERFORD
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State | TX
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Zip | 76086-1266
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Country | US
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Telephone | 817-739-7428
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTINA SUE TURNER
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Credential | LPC
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Telephone | 817-739-7428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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