Healthcare Provider Details

I. General information

NPI: 1922929389
Provider Name (Legal Business Name): MASON GLENN SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 TERRY ST
LONGMONT CO
80501-5930
US

IV. Provider business mailing address

156 ELDORADO SPRINGS DR # 231
ELDORADO SPRINGS CO
80025-5009
US

V. Phone/Fax

Practice location:
  • Phone: 303-578-0527
  • Fax:
Mailing address:
  • Phone: 760-920-6638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: