Healthcare Provider Details

I. General information

NPI: 1073670501
Provider Name (Legal Business Name): STACEY MASON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NE MISSOURI RD SUITE 302
LEES SUMMIT MO
64086-4720
US

IV. Provider business mailing address

200 NE MISSOURI RD SUITE 302
LEES SUMMIT MO
64086-4720
US

V. Phone/Fax

Practice location:
  • Phone: 816-523-0103
  • Fax: 816-361-6471
Mailing address:
  • Phone: 816-523-0103
  • Fax: 816-361-6471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2000172763
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: