MEDICARE: ROBERT MASSON LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	11271	TX

General Provider Information

NPI Number	:	1528495546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT MASSON LCDC

Provider Business Mailing Address
First Line	:	2600 K AVE
Second Line	:	STE 102
City	:	PLANO
State	:	TX
Zip	:	75074-5306
Country	:	US
Telephone Number	:	972-423-8727
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 K AVE
Second Line	:	STE 102
City	:	PLANO
State	:	TX
Zip	:	75074-5306
Country	:	US
Telephone Number	:	972-423-8727
Fax Number	:

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

Provider Enumeration Date	:	10/04/2013
Last Update Date	:	10/04/2013

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