Provider Demographics
NPI:1306476528
Name:MASON, KELLY (MS, LPC, CAADC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:MS, LPC, CAADC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:OLENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:313 W LIBERTY ST STE 350
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2780
Mailing Address - Country:US
Mailing Address - Phone:717-947-4750
Mailing Address - Fax:
Practice Address - Street 1:313 W LIBERTY ST STE 124
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2766
Practice Address - Country:US
Practice Address - Phone:717-397-9118
Practice Address - Fax:717-397-3514
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011270101YP2500X
PA12303101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)