Provider Demographics
NPI:1245675065
Name:DODD, MARK CHRISTOPHER
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:DODD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 912
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50402-0912
Mailing Address - Country:US
Mailing Address - Phone:641-201-1521
Mailing Address - Fax:641-201-1521
Practice Address - Street 1:103 E STATE ST
Practice Address - Street 2:STE 301
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-3300
Practice Address - Country:US
Practice Address - Phone:641-201-1521
Practice Address - Fax:641-201-1521
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA97003101YA0400X
IA00293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)