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General NPI Number Information
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NPI Number | 1326646944
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Entity Type | Organization
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Legal Business Name | MOSAIC COUNSELING SERVICES
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 1921 CARLISLE BLVD NE STE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-4971
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Country | US
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Telephone | 505-750-4243
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Fax |
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Provider Business Mailing Address
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Address Line | 4804 OVERLAND ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-2667
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Country | US
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Telephone | 505-750-4243
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIE K GRAY
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Credential | LCSW
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Telephone | 505-720-3781
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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