Healthcare Provider Details

I. General information

NPI: 1265258651
Provider Name (Legal Business Name): MASON WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 LAKEVIEW PKWY
ROWLETT TX
75088-4177
US

IV. Provider business mailing address

3705 LAKEVIEW PKWY
ROWLETT TX
75088-4177
US

V. Phone/Fax

Practice location:
  • Phone: 972-809-9597
  • Fax:
Mailing address:
  • Phone: 972-809-9597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number102004
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: