Provider Demographics
NPI:1093288854
Name:MASON, GREGORY EARL (LPC-S)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:EARL
Last Name:MASON
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 DEVONSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-1921
Mailing Address - Country:US
Mailing Address - Phone:979-220-6754
Mailing Address - Fax:
Practice Address - Street 1:707 TEXAS AVE S STE 206A
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-1975
Practice Address - Country:US
Practice Address - Phone:979-220-6754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18641101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty