Provider Demographics
NPI:1023871209
Name:MASON, KAI TAYLOR (MA, LADC, LPCC)
Entity type:Individual
Prefix:
First Name:KAI
Middle Name:TAYLOR
Last Name:MASON
Suffix:
Gender:F
Credentials:MA, LADC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15645 24TH AVE N UNIT H
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-6462
Mailing Address - Country:US
Mailing Address - Phone:651-274-5770
Mailing Address - Fax:
Practice Address - Street 1:8640 EAGLE CREEK CIR
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-4400
Practice Address - Country:US
Practice Address - Phone:952-746-7664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC04227101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health