Healthcare Provider Details

I. General information

NPI: 1124554555
Provider Name (Legal Business Name): TERRY WAYNE MASON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 FLETCHER BLVD
AMES IA
50010-4167
US

IV. Provider business mailing address

3705 FLETCHER BLVD
AMES IA
50010-4167
US

V. Phone/Fax

Practice location:
  • Phone: 515-460-1318
  • Fax:
Mailing address:
  • Phone: 515-460-1318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number00444
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number00444
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: