NPIMap

Organization Active NPI

Mosaic Mental Wellness

  • Mental Health Counselor
  • Roanoke, VA
National Provider Identifier
1114588241
Registry record updated May 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
MOSAIC MENTAL WELLNESS
Practice address
3005 Peters Creek Rd NW
Roanoke, VA 24019-2738
Phone
(540) 520-1052
NPI assigned
Jun 28, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2020

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

Authorized official

Name
Deneen Logan EvansNPI 1811579824
Title
Owner
Phone
(540) 566-4034

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

3005 Peters Creek Rd NW
Roanoke, VA 24019-2738

Mailing address

3005 Peters Creek Rd NW
Roanoke, VA 24019-2738
Phone (540) 566-4034

Other names 1

  • Mosaic Mental Wellness and Health Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL www.mosaiccounselingservices.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200610002687 VA Part B Supplier - Clinic/Group Practice 2062833403 Receives reassigned benefits from 6 practitioners
Practice locations: Roanoke, VA

National Provider Directory

National Provider Directory

Locations

7533 Williamson Rd
Roanoke, VA 24019
Phone (540) 362-1676

Practitioners & affiliated clinicians

Practitioners 9

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": "1561680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589155200000",
    "number": "1114588241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3005 PETERS CREEK RD NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240192738",
            "telephone_number": "540-566-4034",
            "fax_number": "540-566-4472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3005 PETERS CREEK RD NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240192738",
            "telephone_number": "540-520-1052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSAIC MENTAL WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-28",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "DENEEN",
        "authorized_official_middle_name": "LOGAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "540-566-4034"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.mosaiccounselingservices.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3005 Peters Creek Rd NW",
            "city": "Roanoke",
            "state": "VA",
            "country_code": "US",
            "postal_code": "240192738",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Mosaic Mental Wellness and Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.