Provider Demographics
NPI:1831460344
Name:MASON, JIM
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:MASON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 KNIGHT ST STE B
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4257
Mailing Address - Country:US
Mailing Address - Phone:509-943-8484
Mailing Address - Fax:509-943-8483
Practice Address - Street 1:503 KNIGHT ST STE B
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4257
Practice Address - Country:US
Practice Address - Phone:509-943-8484
Practice Address - Fax:509-943-8483
Is Sole Proprietor?:No
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60143003101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor