MEDICARE: TANITSHA KEISHAUN MASON LCSW

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	1041C0700X	Clinical Social Worker	5546-C	NV

General Provider Information

NPI Number	:	1407099278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANITSHA KEISHAUN MASON LCSW

Provider Business Mailing Address
First Line	:	3085 S JONES BLVD STE D
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6767
Country	:	US
Telephone Number	:	702-888-0036
Fax Number	:	702-888-0035

Provider Business Practice Location Address
First Line	:	3085 S JONES BLVD STE D
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6767
Country	:	US
Telephone Number	:	702-888-0036
Fax Number	:	702-888-0035

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

Provider Enumeration Date	:	04/09/2009
Last Update Date	:	01/14/2021

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