Healthcare Provider Details

I. General information

NPI: 1306476528
Provider Name (Legal Business Name): KELLY MASON MS, LPC, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY OLENA

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 W LIBERTY ST STE 124
LANCASTER PA
17603-2766
US

IV. Provider business mailing address

313 W LIBERTY ST STE 350
LANCASTER PA
17603-2780
US

V. Phone/Fax

Practice location:
  • Phone: 717-397-9118
  • Fax: 717-397-3514
Mailing address:
  • Phone: 717-947-4750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12303
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC011270
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: