Provider Demographics
NPI:1992145742
Name:MASON, MONA M
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:M
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 1:1760 GLOUCESTER DR # 2
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-3710
Mailing Address - Country:US
Mailing Address - Phone:708-951-4756
Mailing Address - Fax:
Practice Address - Street 1:1760 GLOUCESTER DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-3710
Practice Address - Country:US
Practice Address - Phone:708-951-4756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008256101YP2500X
OHE1800661101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional