Provider Demographics
NPI:1497796759
Name:MASON, DIANNE T (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:T
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:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-0170
Mailing Address - Country:US
Mailing Address - Phone:541-557-1518
Mailing Address - Fax:541-996-4004
Practice Address - Street 1:2015 NW 39TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-4824
Practice Address - Country:US
Practice Address - Phone:541-557-1518
Practice Address - Fax:541-996-4004
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR210628Medicaid
OR210628Medicaid