Provider Demographics
NPI:1457666851
Name:MASON, LA GRANDE ERON JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:LA GRANDE
Middle Name:ERON
Last Name:MASON
Suffix:JR
Gender:M
Credentials:PHD
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Mailing Address - Street 1:3717 S LA BREA AVE
Mailing Address - Street 2:PMB #325
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-5300
Mailing Address - Country:US
Mailing Address - Phone:866-773-4303
Mailing Address - Fax:866-773-4303
Practice Address - Street 1:11500 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1524
Practice Address - Country:US
Practice Address - Phone:310-242-8608
Practice Address - Fax:866-773-4303
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor