Provider Demographics
NPI:1043605736
Name:MASON, KATHRINE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:KATHRINE
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 29TH AVE
Mailing Address - Street 2:SUITE 13
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2843
Mailing Address - Country:US
Mailing Address - Phone:228-669-5283
Mailing Address - Fax:
Practice Address - Street 1:1520 29TH AVE
Practice Address - Street 2:SUITE 13
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2843
Practice Address - Country:US
Practice Address - Phone:228-669-5283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1984101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor