Provider Demographics
NPI:1598107203
Name:MASON, ANTHONY (LPC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:MASON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 CRAWFORD CT
Mailing Address - Street 2:201
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2279
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1208 CRAWFORD CT
Practice Address - Street 2:201
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2279
Practice Address - Country:US
Practice Address - Phone:214-385-0509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional