Healthcare Provider Details

I. General information

NPI: 1629876784
Provider Name (Legal Business Name): PRICE MASON MA, LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CLUB RD STE 160
EUGENE OR
97401-2439
US

IV. Provider business mailing address

PO BOX 70779
SPRINGFIELD OR
97475-0137
US

V. Phone/Fax

Practice location:
  • Phone: 541-345-1722
  • Fax: 541-485-7049
Mailing address:
  • Phone: 541-345-1722
  • Fax: 541-485-7049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC9939
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number05385
License Number StateAL

VII. Legacy identifiers

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

# 1
Identifier16442714
Identifier TypeOTHER
Identifier State
Identifier IssuerCAQH
# 2
Identifier500860455
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: