Provider Demographics
NPI:1629775374
Name:MASON, NEFERTIA Y (MED, LPCC, NBCC)
Entity Type:Individual
Prefix:
First Name:NEFERTIA
Middle Name:Y
Last Name:MASON
Suffix:
Gender:F
Credentials:MED, LPCC, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 LOUIS COLEMAN JR DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-1809
Mailing Address - Country:US
Mailing Address - Phone:502-416-8060
Mailing Address - Fax:
Practice Address - Street 1:1939 GOLDSMITH LN STE 130
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3175
Practice Address - Country:US
Practice Address - Phone:502-822-3178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY275596101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY275596OtherKENTUCKY BOARD OF LICENSED PROFESSIONAL COUNSELORS- LICENSE NUMBER