| Mosaic Center For Integrative Therapy, Llc | |
|
2202 Mitchell Park Dr Suite 2b Petoskey MI 49770-8897 | |
| (231) 487-1750 | |
| (231) 487-1754 |
| Full Name | Mosaic Center For Integrative Therapy, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2202 Mitchell Park Dr, Petoskey, Michigan |
| Authorized Official Name and Position | Brenda Ennis (BUSNIESS OWNER / THERAPIST) |
| Authorized Official Contact | 2314871750 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mosaic Center For Integrative Therapy, Llc 2202 Mitchell Park Dr Suite 2b Petoskey MI 49770-8897 Ph: (231) 487-1750 | Mosaic Center For Integrative Therapy, Llc 2202 Mitchell Park Dr Suite 2b Petoskey MI 49770-8897 Ph: (231) 487-1750 |
| NPI Number | 1518208008 |
|---|---|
| Provider Enumeration Date | 03/07/2013 |
| Last Update Date | 11/01/2013 |
| Medicare PECOS PAC ID | 0042445645 |
|---|---|
| Medicare Enrollment ID | O20131107001246 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518208008 | NPI | - | NPPES |
| 1386972446 | Other | TYPE I NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 6801085534 (Michigan) | Primary |
| Provider Name | Brenda Ennis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386972446 PECOS PAC ID: 1951536556 Enrollment ID: I20131107001652 |
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