=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639020837
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOSAIC HEALING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2026
-----------------------------------------------------
Last Update Date | 02/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 GENESSEE ST
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64102-1039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-699-0103
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1608 S HARRIS AVE
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64052-3730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-724-1613
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL SOCIAL WORKER/THERAPIST
-----------------------------------------------------
Name | SANDRA FAIRBANKS
-----------------------------------------------------
Credential | LCSW, LSCSW
-----------------------------------------------------
Telephone | 816-699-0103
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------