Provider Demographics
NPI:1003944950
Name:MASON, ANNE (LMFT MSED)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:LMFT MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 FRANCK AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2543
Mailing Address - Country:US
Mailing Address - Phone:502-897-7342
Mailing Address - Fax:592-899-3483
Practice Address - Street 1:122 FRANCK AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2543
Practice Address - Country:US
Practice Address - Phone:502-897-7342
Practice Address - Fax:592-899-3483
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0516106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1091OtherFIRST STEPS
KYKY-0516OtherLICENCED MARRIAGE & FAMIL