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Organization

MOSAIC CENTER FOR INTEGRATIVE THERAPY, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BRENDA ENNIS (BUSNIESS OWNER / THERAPIST)
(231) 487-1750
Entity
Organization

Contact information

Practice address
2202 MITCHELL PARK DR, SUITE 2B, PETOSKEY, MI 49770-8897
(231) 487-1750
(231) 487-1754
Mailing address
2202 MITCHELL PARK DR, SUITE 2B, PETOSKEY, MI 49770-8897
(231) 487-1750
(231) 487-1754

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
6801085534
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1386972446
TYPE I NPI
Enumeration date
03/07/2013
Last updated
11/01/2013
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