Provider Demographics
NPI:1043379761
Name:MASON-MCFALL, DONNA G (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:G
Last Name:MASON-MCFALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75652-6077
Mailing Address - Country:US
Mailing Address - Phone:903-655-0123
Mailing Address - Fax:903-655-0123
Practice Address - Street 1:3118 H G MOSLEY PKWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2941
Practice Address - Country:US
Practice Address - Phone:903-655-0123
Practice Address - Fax:903-722-2624
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16170101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1515652-01Medicaid