MEDICARE: MICHAEL MASON LPC

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
1	101YP2500X	Professional Counselor	2021011824	MO

General Provider Information

NPI Number	:	1154900975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL MASON LPC

Provider Business Mailing Address
First Line	:	3106 PEARL HARBOR DR
Second Line	:
City	:	SAINT ANN
State	:	MO
Zip	:	63074-3809
Country	:	US
Telephone Number	:	314-683-0278
Fax Number	:

Provider Business Practice Location Address
First Line	:	3106 PEARL HARBOR DR
Second Line	:
City	:	SAINT ANN
State	:	MO
Zip	:	63074-3809
Country	:	US
Telephone Number	:	314-683-0278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2021
Last Update Date	:	04/28/2024

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