Healthcare Provider Details

I. General information

NPI: 1821170325
Provider Name (Legal Business Name): JOANNE B MASON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 08/28/2007

III. Provider practice location address

6147 SUTTER AVENUE
CARMICHAEL CA
95608-2738
US

IV. Provider business mailing address

6147 SUTTER AVENUE
CARMICHAEL CA
95608-2738
US

V. Phone/Fax

Practice location:
  • Phone: 916-971-7640
  • Fax: 916-971-5711
Mailing address:
  • Phone: 916-971-7640
  • Fax: 916-971-5711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC23495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: