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General NPI Number Information
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NPI Number | 1295183218
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Entity Type | Organization
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Legal Business Name | MOSAIC COUNSELING GROUP LLC
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 3430 OAKWOOD MALL DR
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City | EAU CLAIRE
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State | WI
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Zip | 54701-3850
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Country | US
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Telephone | 715-864-1187
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Fax |
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Provider Business Mailing Address
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Address Line | 724 S MAIN ST
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-3218
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | JODI BRIGHT
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Credential | LPC
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Telephone | 715-864-1187
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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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