Provider Demographics
NPI:1922190834
Name:MASTOR MENTAL HEALTH AND ASSOCIATES PC
Entity Type:Organization
Organization Name:MASTOR MENTAL HEALTH AND ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ELIA
Authorized Official - Last Name:MASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-662-6500
Mailing Address - Street 1:206 JOE V KNOX AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-7911
Mailing Address - Country:US
Mailing Address - Phone:704-662-6500
Mailing Address - Fax:704-662-6503
Practice Address - Street 1:206 JOE V KNOX AVE
Practice Address - Street 2:SUITE F
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-7911
Practice Address - Country:US
Practice Address - Phone:704-662-6500
Practice Address - Fax:704-662-6503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty