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General NPI Number Information
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NPI Number | 1053973040
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Entity Type | Individual
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Provider Name | WILMA KAY MAST PCC
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Gender | Female
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Dates
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Enumeration Date | 07/01/2019
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 151 MARION AVE
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City | MANSFIELD
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State | OH
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Zip | 44903-2223
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Country | US
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Telephone | 419-774-9969
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Fax |
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Provider Business Mailing Address
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Address Line | 6183 COUNTY ROAD 207
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City | MILLERSBURG
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State | OH
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Zip | 44654-9024
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Country | US
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Telephone | 330-473-8358
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C1901870
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.2102418
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License Number State | OH
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