Provider Demographics
NPI:1992012066
Name:STEVENS, MASON CURTIS (LCSW)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:CURTIS
Last Name:STEVENS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3522 BRIAR CREEK LN
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-4728
Mailing Address - Country:US
Mailing Address - Phone:208-529-1660
Mailing Address - Fax:
Practice Address - Street 1:269 W 780 S
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5467
Practice Address - Country:US
Practice Address - Phone:435-890-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9094603-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical