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General NPI Number Information
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NPI Number | 1922793215
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Entity Type | Organization
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Legal Business Name | MOSAIC NATURE THERAPY AND WELLNESS PLLC
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Dates
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Enumeration Date | 04/11/2023
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Last Update Date | 03/01/2025
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Provider Practice Location Address
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Address Line | 935 175TH ST STE 100
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City | HOMEWOOD
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State | IL
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Zip | 60430-2073
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Country | US
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Telephone | 773-888-9830
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Fax | 309-240-9591
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Provider Business Mailing Address
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Address Line | 935 175TH ST STE 100
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City | HOMEWOOD
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State | IL
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Zip | 60430-2073
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Country | US
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Telephone | 773-888-9830
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Fax | 309-240-9591
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Authorized Official
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Title or Position | OWNER
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Name | ROSA VERA KING
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Credential | LCPC
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Telephone | 708-928-3288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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