Provider Demographics
NPI:1275844961
Name:MASON, SHURKELA LAVETTE (LPC)
Entity Type:Individual
Prefix:MS
First Name:SHURKELA
Middle Name:LAVETTE
Last Name:MASON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2503 S LINDEN RD STE 270
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5456
Mailing Address - Country:US
Mailing Address - Phone:810-853-9795
Mailing Address - Fax:810-213-1471
Practice Address - Street 1:2503 S LINDEN RD STE 270
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5456
Practice Address - Country:US
Practice Address - Phone:810-853-9795
Practice Address - Fax:810-213-1471
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012073101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1275844961Medicaid