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NPI Code Detail

MEDICARE: CAROLYN RAE MASON MS, CDP

MEDICARE: CAROLYN RAE MASON MS, CDP
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCP60580897WA

General Provider Information

NPI Number : 1548756422
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN RAE MASON MS, CDP
Provider Business Mailing Address
First Line : 4120 MERIDIAN ST STE 220
Second Line :
City : BELLINGHAM
State : WA
Zip : 98226-5575
Country : US
Telephone Number : 541-861-0400
Fax Number :
Provider Business Practice Location Address
First Line : 4120 MERIDIAN ST STE 220
Second Line :
City : BELLINGHAM
State : WA
Zip : 98226-5575
Country : US
Telephone Number : 541-861-0400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2018
Last Update Date : 07/03/2018

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