=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790258796
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOSAIC COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2019
-----------------------------------------------------
Last Update Date | 06/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5780 STATE ROUTE 13
-----------------------------------------------------
City | BELLVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44813-9014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-307-3382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5780 STATE ROUTE 13
-----------------------------------------------------
City | BELLVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44813-9014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-307-3382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | CRISTINA STEINER
-----------------------------------------------------
Credential | LPCC
-----------------------------------------------------
Telephone | 567-307-3382
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------