Provider Demographics
NPI:1962249680
Name:MASON, MARY RICHELLE (PMHNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:RICHELLE
Last Name:MASON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 NASHVILLE AVE # 202
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1906
Mailing Address - Country:US
Mailing Address - Phone:806-687-0047
Mailing Address - Fax:
Practice Address - Street 1:8200 NASHVILLE AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1906
Practice Address - Country:US
Practice Address - Phone:214-734-1654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1168660363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health