MEDICARE: CANDICE MASON MA, LPC, BHP

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	LPC-18158	AZ

General Provider Information

NPI Number	:	1952957243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE MASON MA, LPC, BHP

Provider Business Mailing Address
First Line	:	3450 N 3RD ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2331
Country	:	US
Telephone Number	:	480-820-5422
Fax Number	:

Provider Business Practice Location Address
First Line	:	1255 W BASELINE RD STE 138B
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-5821
Country	:	US
Telephone Number	:	480-820-5422
Fax Number	:

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

Provider Enumeration Date	:	08/13/2019
Last Update Date	:	08/13/2019

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