Provider Demographics
NPI:1275966160
Name:MASON, LYNNETTE MARIE
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:MARIE
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNNETTE
Other - Middle Name:MARIE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2248 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5659
Mailing Address - Country:US
Mailing Address - Phone:405-604-1199
Mailing Address - Fax:
Practice Address - Street 1:2248 MAPLE DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5659
Practice Address - Country:US
Practice Address - Phone:405-604-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health