Provider Demographics
NPI:1891223756
Name:MOSAIC COUNSELING, LLC
Entity Type:Organization
Organization Name:MOSAIC COUNSELING, LLC
Other - Org Name:LIFE AND HOPE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:352-501-8210
Mailing Address - Street 1:33211 KAYLEE WAY
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3831
Mailing Address - Country:US
Mailing Address - Phone:352-501-8210
Mailing Address - Fax:407-867-6316
Practice Address - Street 1:4400 N HIGHWAY 19A STE 5
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2022
Practice Address - Country:US
Practice Address - Phone:352-501-8210
Practice Address - Fax:407-867-6316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3121106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016559600Medicaid