Provider Demographics
NPI:1356091169
Name:MASON, KRISTIN ELLEN
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELLEN
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:VT
Mailing Address - Zip Code:05853-0146
Mailing Address - Country:US
Mailing Address - Phone:802-895-9166
Mailing Address - Fax:802-895-9177
Practice Address - Street 1:574 SUNSET DRIVE
Practice Address - Street 2:
Practice Address - City:MORGAN
Practice Address - State:VT
Practice Address - Zip Code:05853-0146
Practice Address - Country:US
Practice Address - Phone:802-895-9166
Practice Address - Fax:802-895-9177
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134464101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health