Healthcare Provider Details

I. General information

NPI: 1518523406
Provider Name (Legal Business Name): MASON D MCDONALD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 N 1200 W
OREM UT
84057-2449
US

IV. Provider business mailing address

1433 N 1200 W
OREM UT
84057-2449
US

V. Phone/Fax

Practice location:
  • Phone: 801-655-5450
  • Fax: 385-225-9327
Mailing address:
  • Phone: 801-655-5450
  • Fax: 385-225-9327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13423814-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: