Provider Demographics
NPI:1912731720
Name:MASON, AUTUMN DAWN
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:DAWN
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12770 CIMARRON PATH STE 118
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3415
Mailing Address - Country:US
Mailing Address - Phone:855-374-4900
Mailing Address - Fax:
Practice Address - Street 1:12770 CIMARRON PATH STE 118
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3415
Practice Address - Country:US
Practice Address - Phone:855-374-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-23-281364106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician