=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922929389
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MASON GLENN SMITH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2026
-----------------------------------------------------
Last Update Date | 07/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 229 TERRY ST
-----------------------------------------------------
City | LONGMONT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80501-5930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-578-0527
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 156 ELDORADO SPRINGS DR # 231
-----------------------------------------------------
City | ELDORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80025-5009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-920-6638
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------