MEDICARE: MORIAH ELIZABETH MASON CSW

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	13930928-3502	UT

General Provider Information

NPI Number	:	1528815024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORIAH ELIZABETH MASON CSW

Provider Business Mailing Address
First Line	:	5103 S WINTERGREEN CIR
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84123-4636
Country	:	US
Telephone Number	:	208-709-6292
Fax Number	:

Provider Business Practice Location Address
First Line	:	4505 S WASATCH BLVD STE 290
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84124-4204
Country	:	US
Telephone Number	:	385-695-5949
Fax Number	:

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

Provider Enumeration Date	:	05/02/2024
Last Update Date	:	05/02/2024

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