Provider Demographics
NPI:1922793215
Name:MOSAIC NATURE THERAPY AND WELLNESS PLLC
Entity type:Organization
Organization Name:MOSAIC NATURE THERAPY AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:VERA
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-928-3288
Mailing Address - Street 1:935 175TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2073
Mailing Address - Country:US
Mailing Address - Phone:773-888-9830
Mailing Address - Fax:309-240-9591
Practice Address - Street 1:935 175TH ST STE 100
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2073
Practice Address - Country:US
Practice Address - Phone:773-888-9830
Practice Address - Fax:309-240-9591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)