Provider Demographics
NPI:1134734569
Name:MASON, JAMES ROBERT (CMHC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:MASON
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9091 E 100 S
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84317-9608
Mailing Address - Country:US
Mailing Address - Phone:801-334-2694
Mailing Address - Fax:
Practice Address - Street 1:9091 E 100 S
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84317-9608
Practice Address - Country:US
Practice Address - Phone:801-334-2694
Practice Address - Fax:801-334-2694
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1134734569Medicaid