Provider Demographics
NPI:1740202068
Name:MASON, MICHAEL LEE (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:MASON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 ALAMO DR
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-3734
Mailing Address - Country:US
Mailing Address - Phone:406-727-0041
Mailing Address - Fax:
Practice Address - Street 1:915 1ST AVE S
Practice Address - Street 2:CENTER FOR MENTAL HEALTH
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3705
Practice Address - Country:US
Practice Address - Phone:406-791-9504
Practice Address - Fax:406-761-0554
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT310103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000051481OtherBLUE CROSS/SHIELD OF MT
MT000005187Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MT0000051481OtherBLUE CROSS/SHIELD OF MT