Provider Demographics
NPI:1013356179
Name:WORD MASON
Entity Type:Organization
Organization Name:WORD MASON
Other - Org Name:WORD MASON,LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:208-293-5673
Mailing Address - Street 1:1503 TETON AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-2266
Mailing Address - Country:US
Mailing Address - Phone:208-293-5673
Mailing Address - Fax:
Practice Address - Street 1:1503 TETON AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-2266
Practice Address - Country:US
Practice Address - Phone:208-293-5673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134131048OtherPROVIDER INDIVIDUAL NPI NUMBER