Provider Demographics
NPI:1699149161
Name:MASON, CRISTINE LOU (LPC)
Entity type:Individual
Prefix:MS
First Name:CRISTINE
Middle Name:LOU
Last Name:MASON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:CRISTINE
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2940 WHEATFIELD FARMS DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7848
Mailing Address - Country:US
Mailing Address - Phone:636-544-3928
Mailing Address - Fax:
Practice Address - Street 1:2940 WHEATFIELD FARMS DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7848
Practice Address - Country:US
Practice Address - Phone:636-544-3928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-21
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001011572101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional