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General NPI Number Information
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NPI Number | 1649575341
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Entity Type | Individual
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Provider Name | KIRSTEN MARIE MASON PSYD
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Gender | Female
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Dates
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Enumeration Date | 01/11/2011
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Last Update Date | 04/20/2023
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Provider Practice Location Address
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Address Line | 100 FOLSOM PRISON RD
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City | REPRESA
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State | CA
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Zip | 95671-3172
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Country | US
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Telephone | 916-985-8610
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Fax |
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Provider Business Mailing Address
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Address Line | 6884 SCHINDLER RD
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City | NEWCASTLE
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State | CA
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Zip | 95658-9437
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Country | US
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Telephone | 925-768-7662
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY30991
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License Number State | CA
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