Healthcare Provider Details

I. General information

NPI: 1255651824
Provider Name (Legal Business Name): GREGORY ALAN MASON LPC CMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 N 700 W SUITE 241
LAYTON UT
84041-5673
US

IV. Provider business mailing address

475 N 300 W SUITE 10
KAYSVILLE UT
84037-3125
US

V. Phone/Fax

Practice location:
  • Phone: 801-690-3502
  • Fax:
Mailing address:
  • Phone: 801-690-3502
  • Fax: 801-546-3422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number68222416004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6822241-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: