Provider Demographics
NPI:1528815024
Name:MASON, MORIAH ELIZABETH (CSW)
Entity type:Individual
Prefix:
First Name:MORIAH
Middle Name:ELIZABETH
Last Name:MASON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5103 S WINTERGREEN CIR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-4636
Mailing Address - Country:US
Mailing Address - Phone:208-709-6292
Mailing Address - Fax:
Practice Address - Street 1:4505 S WASATCH BLVD STE 290
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84124-4204
Practice Address - Country:US
Practice Address - Phone:385-695-5949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13930928-3502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health