Provider Demographics
NPI:1255651824
Name:MASON, GREGORY ALAN (LPC CMHC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ALAN
Last Name:MASON
Suffix:
Gender:M
Credentials:LPC CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 N 300 W
Mailing Address - Street 2:SUITE 10
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-3125
Mailing Address - Country:US
Mailing Address - Phone:801-690-3502
Mailing Address - Fax:801-546-3422
Practice Address - Street 1:1916 N 700 W
Practice Address - Street 2:SUITE 241
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5673
Practice Address - Country:US
Practice Address - Phone:801-690-3502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6822241-60041041C0700X
UT68222416004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT8205653-0162OtherUTAH BUSINESS REGISTRY