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General NPI Number Information
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NPI Number | 1467818153
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Entity Type | Individual
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Provider Name | MARTHA MASON
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Gender | Female
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Dates
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Enumeration Date | 01/11/2016
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 13055 W MCDOWELL RD SUITE G-112
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City | AVONDALE
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State | AZ
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Zip | 85392-6449
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Country | US
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Telephone | 623-792-5021
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Fax | 623-792-5262
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Provider Business Mailing Address
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Address Line | 218 E EUGIE AVE
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City | PHOENIX
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State | AZ
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Zip | 85022-4726
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Country | US
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Telephone | 602-866-0370
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC-1568
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License Number State | AZ
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