Provider Demographics
NPI:1760008239
Name:MASON, ALTHA GAIL
Entity Type:Individual
Prefix:
First Name:ALTHA
Middle Name:GAIL
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E BLITHEDALE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1596
Mailing Address - Country:US
Mailing Address - Phone:415-505-0723
Mailing Address - Fax:
Practice Address - Street 1:700 E BLITHEDALE AVE STE 2
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1596
Practice Address - Country:US
Practice Address - Phone:415-505-0723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17462106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist