Provider Demographics
NPI:1457003659
Name:MASON, SHELLEY MILLS (LGPC)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:MILLS
Last Name:MASON
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10610 SIREN LN
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-2793
Mailing Address - Country:US
Mailing Address - Phone:443-614-2281
Mailing Address - Fax:
Practice Address - Street 1:10610 SIREN LN
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-2793
Practice Address - Country:US
Practice Address - Phone:443-614-2281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12027101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional