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General NPI Number Information
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NPI Number | 1932386802
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Entity Type | Individual
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Provider Name | BRENDA ANN MASON LCPC
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Gender | Female
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | 747 E ETNA RD
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City | OTTAWA
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State | IL
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Zip | 61350-3777
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Country | US
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Telephone | 815-993-1614
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Fax |
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Provider Business Mailing Address
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Address Line | 1317 FLAGG RD
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City | DIXON
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State | IL
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Zip | 61021-8949
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Country | US
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Telephone | 815-677-6650
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 26644
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License Number State | IL
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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 | 180.010067
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License Number State | IL
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