Provider Demographics
NPI:1922689603
Name:MASON, MELANIE JEAN (CPSS, CFSP)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:JEAN
Last Name:MASON
Suffix:
Gender:F
Credentials:CPSS, CFSP
Other - Prefix:MISS
Other - First Name:MELANIE
Other - Middle Name:JEAN
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 RANDY DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401
Mailing Address - Country:US
Mailing Address - Phone:208-243-2223
Mailing Address - Fax:
Practice Address - Street 1:611 RANDY DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401
Practice Address - Country:US
Practice Address - Phone:208-243-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID103TF0000X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily