Provider Demographics
NPI:1679167126
Name:MOSAIC THERAPY GROUP
Entity Type:Organization
Organization Name:MOSAIC THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWENKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:651-398-6877
Mailing Address - Street 1:5324 27TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1930
Mailing Address - Country:US
Mailing Address - Phone:651-398-6877
Mailing Address - Fax:
Practice Address - Street 1:5324 27TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-1930
Practice Address - Country:US
Practice Address - Phone:651-398-6877
Practice Address - Fax:612-315-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty