Healthcare Provider Details

I. General information

NPI: 1295920296
Provider Name (Legal Business Name): BRIAN O. MASON LCSW, LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 PENTECOST HWY
ONSTED MI
49265-9638
US

IV. Provider business mailing address

214 PENTECOST HWY
ONSTED MI
49265-9638
US

V. Phone/Fax

Practice location:
  • Phone: 815-245-6834
  • Fax:
Mailing address:
  • Phone: 815-245-6834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801119163
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149007751
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: