Provider Demographics
NPI:1134221443
Name:MASON, RICK (LCPC)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:MASON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11187 DUNDEE RD
Mailing Address - Street 2:103
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9246
Mailing Address - Country:US
Mailing Address - Phone:815-575-3752
Mailing Address - Fax:815-759-7298
Practice Address - Street 1:11187 DUNDEE RD
Practice Address - Street 2:103
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-9246
Practice Address - Country:US
Practice Address - Phone:815-575-3752
Practice Address - Fax:815-759-7298
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-006063101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
36-3045007OtherTAX ID#