MEDICARE: JAMIE MASON LPC, CEAP

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	101YP2500X	Professional Counselor	000922	MO

General Provider Information

NPI Number	:	1598766362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE MASON LPC, CEAP

Provider Business Mailing Address
First Line	:	684 REDMANS VICTORY LN
Second Line	:
City	:	OAK GROVE
State	:	MO
Zip	:	64075-5476
Country	:	US
Telephone Number	:	816-690-3586
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 BROADWAY ST
Second Line	:	SUITE 1104
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2658
Country	:	US
Telephone Number	:	816-753-3333
Fax Number	:

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	07/08/2007

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