Provider Demographics
NPI:1891817979
Name:RANDALL- MASON, KATHLEEN (MA)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:RANDALL- MASON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3171 CARIBOU CT
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973
Mailing Address - Country:US
Mailing Address - Phone:530-899-8015
Mailing Address - Fax:
Practice Address - Street 1:426 BROADWAY ST STE 202
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928
Practice Address - Country:US
Practice Address - Phone:530-899-8015
Practice Address - Fax:530-892-2900
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29220106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1891817979OtherNPI