MEDICARE: MS. DINAH LYNN MASON MFTI

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	106H00000X	Marriage & Family Therapist	IMT 1730	FL

General Provider Information

NPI Number	:	1831450477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DINAH LYNN MASON MFTI

Provider Business Mailing Address
First Line	:	3545 SAINT JOHNS BLUFF RD S
Second Line	:	SUITE 156
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-2682
Country	:	US
Telephone Number	:	904-635-5031
Fax Number	:	904-724-4509

Provider Business Practice Location Address
First Line	:	10175 FORTUNE PKWY
Second Line	:	SUITE 1102
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6746
Country	:	US
Telephone Number	:	904-635-5031
Fax Number	:	904-724-4509

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

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	05/30/2012

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