Healthcare Provider Details

I. General information

NPI: 1073829867
Provider Name (Legal Business Name): LORI LYNN MASE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORI LYNN COLLINS PSY.D.

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 NEWPORT CENTER DRIVE SUITE #650
NEWPORT BEACH CA
92660-7461
US

IV. Provider business mailing address

450 NEWPORT CENTER DRIVE SUITE 650
NEWPORT BEACH CA
92660-7641
US

V. Phone/Fax

Practice location:
  • Phone: 949-644-5800
  • Fax: 949-999-8365
Mailing address:
  • Phone: 949-378-8550
  • Fax: 949-999-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC46845
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number46845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: