Healthcare Provider Details

I. General information

NPI: 1982578530
Provider Name (Legal Business Name): JULIE LANETTE MASK LPC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 7TH ST NE
NORTH CANTON OH
44720-2115
US

IV. Provider business mailing address

1215 7TH ST NE
NORTH CANTON OH
44720-2115
US

V. Phone/Fax

Practice location:
  • Phone: 903-517-4740
  • Fax:
Mailing address:
  • Phone: 903-517-4740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number10161
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10161
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10161
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number10161
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10161
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1142
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: