Provider Demographics
NPI:1508374950
Name:MASON, TRACI (OCPC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:OCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11671 JULIE DR NW
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:OH
Mailing Address - Zip Code:43105-9306
Mailing Address - Country:US
Mailing Address - Phone:614-400-4889
Mailing Address - Fax:
Practice Address - Street 1:11671 JULIE DR NW
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:OH
Practice Address - Zip Code:43105-9306
Practice Address - Country:US
Practice Address - Phone:614-400-4889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOCPC.0991405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional