NPIMap

Organization Active NPI

Moving Mosaic Therapy & Counseling, PLLC

  • Professional Counselor
  • North Riverside, IL
National Provider Identifier
1093474652
Registry record updated Oct 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
MOVING MOSAIC THERAPY & COUNSELING, PLLC
Practice address
2232 S 18TH Ave
North Riverside, IL 60546-1014
Phone
(773) 373-9682
Fax
(773) 312-4876
NPI assigned
Dec 10, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Katie Marie Dominguez, MA, LCPCNPI 1518427731
Title
Co-Founder/Psychotherapist
Phone
(773) 373-9682

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X Primary
Dance TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225600000X

Addresses

Primary practice location

2232 S 18TH Ave
North Riverside, IL 60546-1014

Mailing address

2232 S 18TH Ave
North Riverside, IL 60546-1014
Phone (773) 373-9682

Other practice location 1

7639 N Greenview Ave Apt 3W
Chicago, IL 60626-1291
Phone (773) 373-9682

Other practice location 2

1340 W Granville Ave Apt 1E
Chicago, IL 60660-1920
Phone (773) 234-1967

Other identifiers 4

IdentifierTypeStateIssuer
6839423OtherILAETNA PPO OUTPATIENT PROVIDER
1407515919OtherILNPI
1447804869OtherILNPPES
1518427731OtherILNPI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address admin@movingmosaiccounseling.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696204800000",
    "number": "1093474652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2232 S 18TH AVE",
            "city": "NORTH RIVERSIDE",
            "state": "IL",
            "postal_code": "605461014",
            "telephone_number": "773-373-9682",
            "fax_number": "773-312-4876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2232 S 18TH AVE",
            "city": "NORTH RIVERSIDE",
            "state": "IL",
            "postal_code": "605461014",
            "telephone_number": "773-373-9682",
            "fax_number": "773-312-4876"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7639 N Greenview Ave Apt 3W",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606261291",
            "country_code": "US",
            "telephone_number": "773-373-9682",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1340 W Granville Ave Apt 1E",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606601920",
            "country_code": "US",
            "telephone_number": "773-234-1967",
            "fax_number": "773-312-4876",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MOVING MOSAIC THERAPY & COUNSELING, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-10",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A",
        "authorized_official_last_name": "DOMINGUEZ",
        "authorized_official_first_name": "KATIE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CO-FOUNDER/PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "773-373-9682",
        "authorized_official_credential": "MA, LCPC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dance Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO OUTPATIENT PROVIDER",
            "identifier": "6839423",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1407515919",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1447804869",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1518427731",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admin@movingmosaiccounseling.com",
            "affiliation": "N",
            "endpointDescription": "Direct email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2232 S 18th Ave",
            "city": "North Riverside",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605461014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in North Riverside, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.