Provider Demographics
NPI:1023545076
Name:MASON, STEPHEN LYNN (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:LYNN
Last Name:MASON
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 STATE ROAD 76 APT 5-21
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-5511
Mailing Address - Country:US
Mailing Address - Phone:512-450-4082
Mailing Address - Fax:
Practice Address - Street 1:1200 N PASEO DE ONATE
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2687
Practice Address - Country:US
Practice Address - Phone:505-747-0081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-20
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136365363LP0808X
NM56057363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health