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NPI Code Detail

MEDICARE: OASIS COUNSELING CENTER - GA, LLC

MEDICARE: OASIS COUNSELING CENTER - GA, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1073896429
Entity Type Code : Organization
Provider Name (Legal Business Name) : OASIS COUNSELING CENTER - GA, LLC
Provider Business Mailing Address
First Line : 201 17TH ST NW
Second Line : SUITE 300
City : ATLANTA
State : GA
Zip : 30363-1098
Country : US
Telephone Number : 404-913-7129
Fax Number : 757-301-7211
Provider Business Practice Location Address
First Line : 201 17TH ST NW
Second Line : SUITE 300
City : ATLANTA
State : GA
Zip : 30363-1098
Country : US
Telephone Number : 404-913-7129
Fax Number : 757-301-7211
Authorized Official
Title or Position : CEO
Name : DR. RICHARD M MASON JR.
Credential : PHD, LPC
Telephone Number : 404-913-7129
Provider Enumeration Date : 09/22/2011
Last Update Date : 09/22/2011

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