Provider Demographics
NPI:1245886910
Name:MOSAIC WELLNESS, LLC
Entity type:Organization
Organization Name:MOSAIC WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:EMERY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT-S
Authorized Official - Phone:325-603-1725
Mailing Address - Street 1:5189 TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4529
Mailing Address - Country:US
Mailing Address - Phone:325-603-1725
Mailing Address - Fax:
Practice Address - Street 1:5189 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4529
Practice Address - Country:US
Practice Address - Phone:325-603-1725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-17
Last Update Date:2019-08-17
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