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General NPI Number Information
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NPI Number | 1770324568
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Entity Type | Organization
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Legal Business Name | MOSAIK JOURNEYS LLC
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 1027 W RUDISILL BLVD STE 228
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City | FORT WAYNE
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State | IN
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Zip | 46807-2160
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Country | US
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Telephone | 260-402-4264
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 W RUDISILL BLVD # 3
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City | FORT WAYNE
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State | IN
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Zip | 46807-2168
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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 | DIRECTOR OF OPERATIONS
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Name | TYLER OYER
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Credential |
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Telephone | 260-402-8413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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