Healthcare Provider Details

I. General information

NPI: 1215876974
Provider Name (Legal Business Name): MASON CLEGG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 N TWYMAN RD
INDEPENDENCE MO
64058-3212
US

IV. Provider business mailing address

3205 N TWYMAN RD
INDEPENDENCE MO
64058-3212
US

V. Phone/Fax

Practice location:
  • Phone: 816-791-7229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2026011322
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: