MEDICARE: DORLISA MASON

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	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1962885053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORLISA MASON

Provider Business Mailing Address
First Line	:	7500 W LAKE MEAD BLVD # 9-517
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0297
Country	:	US
Telephone Number	:	702-825-0853
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 W LAKE MEAD BLVD # 9-517
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0297
Country	:	US
Telephone Number	:	702-825-0853
Fax Number	:

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

Provider Enumeration Date	:	07/07/2015
Last Update Date	:	07/07/2015

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Directions to “ DORLISA MASON ” Practice Location

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