Healthcare Provider Details

I. General information

NPI: 1467277871
Provider Name (Legal Business Name): MR. BRIAN FITZGERALD MASON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6771 W CHARLESTON BLVD STE C
LAS VEGAS NV
89146-9016
US

IV. Provider business mailing address

7224 GENTLE VALLEY ST
LAS VEGAS NV
89149-1615
US

V. Phone/Fax

Practice location:
  • Phone: 702-405-8772
  • Fax: 702-405-7451
Mailing address:
  • Phone: 206-697-6089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70153837
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: