Provider Demographics
NPI:1598766362
Name:MASON, JAMIE (LPC, CEAP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:LPC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 REDMANS VICTORY LN
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:64075-5476
Mailing Address - Country:US
Mailing Address - Phone:816-690-3586
Mailing Address - Fax:
Practice Address - Street 1:3100 BROADWAY ST
Practice Address - Street 2:SUITE 1104
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2658
Practice Address - Country:US
Practice Address - Phone:816-753-3333
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000922101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional