Provider Demographics
NPI:1164281952
Name:MASON, MIKAELA JONAI
Entity Type:Individual
Prefix:
First Name:MIKAELA
Middle Name:JONAI
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 CREPE MYRTLE LN
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-3070
Mailing Address - Country:US
Mailing Address - Phone:210-209-7766
Mailing Address - Fax:
Practice Address - Street 1:5210 THOUSAND OAKS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-6974
Practice Address - Country:US
Practice Address - Phone:726-215-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician