Provider Demographics
NPI:1215384060
Name:MASON, RAYDELL JR
Entity Type:Individual
Prefix:
First Name:RAYDELL
Middle Name:
Last Name:MASON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 BARROW ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4764
Mailing Address - Country:US
Mailing Address - Phone:985-746-5900
Mailing Address - Fax:
Practice Address - Street 1:801 BARROW ST
Practice Address - Street 2:SUITE 301
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4764
Practice Address - Country:US
Practice Address - Phone:985-746-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional