Mosaicself Counseling

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

MOSAICSELF COUNSELING

Practice address

10 N 1St Ave E Ste 202
Ely, MN 55731-1473

Phone

(218) 216-8467

NPI assigned

Mar 12, 2021

Last updated

Mar 12, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Corie McKibben, LICSWNPI 1952931586

Title

Owner

Phone

(218) 966-8330

Specialties & licenses 1

Addresses

Other names 1

• Corie McKibben Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Corie Stewart McKibben, MSW, LICSW

  • Clinical Social Worker
  • Ely, MN
  • NPI 1952931586
  Authorized official Same address or phone

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

{
    "created_epoch": "1615507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615507200000",
    "number": "1841875648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 RINGROCK RD",
            "city": "ELY",
            "state": "MN",
            "postal_code": "557318235",
            "telephone_number": "218-966-8330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 N 1ST AVE E STE 202",
            "city": "ELY",
            "state": "MN",
            "postal_code": "557311473",
            "telephone_number": "218-216-8467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSAICSELF COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-12",
        "last_updated": "2021-03-12",
        "certification_date": "2021-03-12",
        "status": "A",
        "authorized_official_last_name": "MCKIBBEN",
        "authorized_official_first_name": "CORIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-966-8330",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corie McKibben",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Robert Mattson, DC CCSP
• Corie Stewart McKibben, MSW, LICSW
• Minneapolis Vamc
• Mitchell David Moe, MD
• James Samuel Montana
• Sarah Murn
• Stephanie Nielsen, WHNP
• Rosa Oesterreich, CPM
• Ol-US Ely, LLC
• Jacob Meyer Osell, PHARM D

• Clinical Social Worker in Ely, MN
• Providers in Ely, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2021; 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.