Provider Demographics
NPI:1407524002
Name:MASON, KELLY CRAWFORD (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:CRAWFORD
Last Name:MASON
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DUNBAR PLZ STE 102
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-3038
Mailing Address - Country:US
Mailing Address - Phone:681-265-9204
Mailing Address - Fax:
Practice Address - Street 1:1 DUNBAR PLZ STE 102
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-3038
Practice Address - Country:US
Practice Address - Phone:681-265-9204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2690101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional