Provider Demographics
NPI:1437936655
Name:SAN TAN PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:SAN TAN PSYCHIATRY PLLC
Other - Org Name:SAN TAN PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:DMSC, PA-C
Authorized Official - Phone:602-888-0370
Mailing Address - Street 1:1910 S STAPLEY DR STE 217
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6679
Mailing Address - Country:US
Mailing Address - Phone:602-888-0370
Mailing Address - Fax:480-748-4095
Practice Address - Street 1:1910 S STAPLEY DR STE 217
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6679
Practice Address - Country:US
Practice Address - Phone:602-888-0370
Practice Address - Fax:480-748-4095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty