Provider Demographics
NPI:1346289840
Name:MASON, RICHARD LEE (CADC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
Last Name:MASON
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-4733
Mailing Address - Country:US
Mailing Address - Phone:270-240-5005
Mailing Address - Fax:270-240-5007
Practice Address - Street 1:1030 E 18TH ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-4733
Practice Address - Country:US
Practice Address - Phone:277-240-5005
Practice Address - Fax:270-240-5007
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0441101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30605018Medicaid