Provider Demographics
NPI:1588208268
Name:MASON, NEVITTA J (LPC)
Entity Type:Individual
Prefix:
First Name:NEVITTA
Middle Name:J
Last Name:MASON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 E EAGLE CREST DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7140
Mailing Address - Country:US
Mailing Address - Phone:928-600-0601
Mailing Address - Fax:
Practice Address - Street 1:460 N SWITZER CANYON DR STE 400
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4851
Practice Address - Country:US
Practice Address - Phone:928-288-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17995101YP2500X
AZLPC-17995101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional