Provider Demographics
NPI:1851065502
Name:MOSAIC COUNSELING AND WELLNESS LLC
Entity Type:Organization
Organization Name:MOSAIC COUNSELING AND WELLNESS LLC
Other - Org Name:MOSAIC COUNSELING AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:708-628-8000
Mailing Address - Street 1:386 N. YORK RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2365
Mailing Address - Country:US
Mailing Address - Phone:708-628-8000
Mailing Address - Fax:
Practice Address - Street 1:1010 LAKE ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1147
Practice Address - Country:US
Practice Address - Phone:708-628-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty