MEDICARE: JULIE LANETTE MASK LPC, LMFT

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	10161	TX
2	106H00000X	Marriage & Family Therapist	1142	TX
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	10161	TX
4	101Y00000X	Counselor	10161	TX
5	101YP2500X	Professional Counselor	10161	TX
6	101YP1600X	Pastoral Counselor	10161	TX

General Provider Information

NPI Number	:	1982578530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE LANETTE MASK LPC, LMFT

Provider Business Mailing Address
First Line	:	1215 7TH ST NE
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-2115
Country	:	US
Telephone Number	:	903-517-4740
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 7TH ST NE
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-2115
Country	:	US
Telephone Number	:	903-517-4740
Fax Number	:

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

Provider Enumeration Date	:	10/06/2025
Last Update Date	:	10/27/2025

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