Provider Demographics
NPI:1508085051
Name:MASON, BROOKE MICHELLE (BS)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:MICHELLE
Last Name:MASON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-1924
Mailing Address - Country:US
Mailing Address - Phone:918-426-6448
Mailing Address - Fax:
Practice Address - Street 1:628 E CREEK AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-6930
Practice Address - Country:US
Practice Address - Phone:918-423-6030
Practice Address - Fax:918-423-2370
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)