| Mosaicself Counseling | |
|
10 N 1st Ave E Ste 202 Ely MN 55731-1473 | |
| (218) 216-8467 | |
| Not Available |
| Full Name | Mosaicself Counseling |
|---|---|
| Speciality | Social Worker |
| Location | 10 N 1st Ave E Ste 202, Ely, Minnesota |
| Authorized Official Name and Position | Corie Mckibben (OWNER) |
| Authorized Official Contact | 2189668330 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mosaicself Counseling 1109 Ringrock Rd Ely MN 55731-8235 Ph: (218) 966-8330 | Mosaicself Counseling 10 N 1st Ave E Ste 202 Ely MN 55731-1473 Ph: (218) 216-8467 |
| NPI Number | 1841875648 |
|---|---|
| Provider Enumeration Date | 03/12/2021 |
| Last Update Date | 03/12/2021 |
| Certification Date | 03/12/2021 |
| Medicare PECOS PAC ID | 2264849884 |
|---|---|
| Medicare Enrollment ID | O20210329000089 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841875648 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Corie S Mckibben |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952931586 PECOS PAC ID: 4587070123 Enrollment ID: I20210308000241 |
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