Provider Demographics
NPI:1275543787
Name:MASON, ANITA F (MA; LMFT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:F
Last Name:MASON
Suffix:
Gender:F
Credentials:MA; LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 HIGHTIDE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-4656
Mailing Address - Country:US
Mailing Address - Phone:217-428-2345
Mailing Address - Fax:
Practice Address - Street 1:363 S MAIN ST STE 340
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62523-1499
Practice Address - Country:US
Practice Address - Phone:217-422-3524
Practice Address - Fax:217-422-3520
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist