Provider Demographics
NPI:1275195737
Name:MOSAIC FAMILY SERVICES, LTD.
Entity Type:Organization
Organization Name:MOSAIC FAMILY SERVICES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:ROBISON
Authorized Official - Last Name:FAUS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:952-217-6419
Mailing Address - Street 1:1405 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071
Mailing Address - Country:US
Mailing Address - Phone:952-217-6419
Mailing Address - Fax:952-758-9022
Practice Address - Street 1:1405 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071
Practice Address - Country:US
Practice Address - Phone:952-217-6419
Practice Address - Fax:952-758-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty