MEDICARE: BRIAN MASAT

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	2007007068	MO

General Provider Information

NPI Number	:	1851062525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN MASAT

Provider Business Mailing Address
First Line	:	11023 MORROW DR
Second Line	:
City	:	SAINT ANN
State	:	MO
Zip	:	63074-3318
Country	:	US
Telephone Number	:	314-925-0330
Fax Number	:

Provider Business Practice Location Address
First Line	:	9733 SAINT CHARLES ROCK RD
Second Line	:
City	:	BRECKENRIDGE HILLS
State	:	MO
Zip	:	63114-2625
Country	:	US
Telephone Number	:	314-423-7030
Fax Number	:

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

Provider Enumeration Date	:	09/23/2021
Last Update Date	:	09/23/2021

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Directions to “ BRIAN MASAT ” Practice Location

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