Provider Demographics
NPI:1407099278
Name:MASON, TANITSHA KEISHAUN (LCSW)
Entity Type:Individual
Prefix:
First Name:TANITSHA
Middle Name:KEISHAUN
Last Name:MASON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3085 S JONES BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6767
Mailing Address - Country:US
Mailing Address - Phone:702-888-0036
Mailing Address - Fax:702-888-0035
Practice Address - Street 1:3085 S JONES BLVD STE D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6767
Practice Address - Country:US
Practice Address - Phone:702-888-0036
Practice Address - Fax:702-888-0035
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5546-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical