MEDICARE: MR. JAMES MASON MA MFT

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	101YM0800X	Mental Health Counselor	41738	CA

General Provider Information

NPI Number	:	1508850058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES MASON MA MFT

Provider Business Mailing Address
First Line	:	3023 1ST AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5815
Country	:	US
Telephone Number	:	619-925-3462
Fax Number	:	619-640-0246

Provider Business Practice Location Address
First Line	:	3023 1ST AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5815
Country	:	US
Telephone Number	:	619-925-3462
Fax Number	:	619-640-0246

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	03/23/2012

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