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General NPI Number Information
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NPI Number | 1780053454
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Entity Type | Individual
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Provider Name | JESSICA RENEE MASON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/23/2015
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Last Update Date | 11/17/2019
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Provider Practice Location Address
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Address Line | 412 E SPOKANE FALLS BLVD # 145D
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City | SPOKANE
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State | WA
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Zip | 99202-2131
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Country | US
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Telephone | 509-358-7533
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Fax | 509-358-7983
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Provider Business Mailing Address
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Address Line | 11805 N ATLANTIC ST
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City | SPOKANE
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State | WA
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Zip | 99218-1956
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Country | US
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Telephone | 928-710-4288
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Fax | 509-358-7983
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PY60618318
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License Number State | WA
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