Provider Demographics
NPI:1639863525
Name:COLWELL, MASON LAIN (BA)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:LAIN
Last Name:COLWELL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:SHADY POINT
Mailing Address - State:OK
Mailing Address - Zip Code:74956-0045
Mailing Address - Country:US
Mailing Address - Phone:918-649-7913
Mailing Address - Fax:
Practice Address - Street 1:107 E RAY FINE BLVD
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:OK
Practice Address - Zip Code:74954-5198
Practice Address - Country:US
Practice Address - Phone:918-427-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator