| Mosaic Therapy | |
|
5350 S Western Ave Oklahoma City OK 73109-4520 | |
| (405) 605-8488 | |
| (888) 877-9894 |
| Full Name | Mosaic Therapy |
|---|---|
| Speciality | Clinic/Center |
| Location | 5350 S Western Ave, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Ja'net Scott (C) |
| Authorized Official Contact | 4056058488 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mosaic Therapy Po Box 890895 Oklahoma City OK 73189-0895 Ph: (405) 605-8488 | Mosaic Therapy 5350 S Western Ave Oklahoma City OK 73109-4520 Ph: (405) 605-8488 |
| NPI Number | 1255623930 |
|---|---|
| Provider Enumeration Date | 05/12/2011 |
| Last Update Date | 10/10/2023 |
| Certification Date | 10/10/2023 |
| Medicare PECOS PAC ID | 3870723802 |
|---|---|
| Medicare Enrollment ID | O20170810000892 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255623930 | NPI | - | NPPES |
| Provider Name | Theresa E Stanley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508106089 PECOS PAC ID: 9638588635 Enrollment ID: I20210504000357 |
| Provider Name | Natasha D Mcfalls |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588299499 PECOS PAC ID: 2163839440 Enrollment ID: I20220926003554 |
| Provider Name | Nolan Arran Lawless |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295066850 PECOS PAC ID: 3375993504 Enrollment ID: I20240423004467 |
| Provider Name | Doris Angelica Baccala |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497531701 PECOS PAC ID: 3274974308 Enrollment ID: I20240507003315 |
| Provider Name | Natalie James Ingram |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851491492 PECOS PAC ID: 8224470554 Enrollment ID: I20240531001191 |
| Provider Name | Samayra Tavakoli |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386002087 PECOS PAC ID: 9638611999 Enrollment ID: I20240603001788 |
| Provider Name | Johnnie Depot |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1902318538 PECOS PAC ID: 9133661705 Enrollment ID: I20240611001840 |
| Provider Name | John Parker Kempf |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1255634341 PECOS PAC ID: 2062954670 Enrollment ID: I20240611002911 |
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