Provider Demographics
NPI:1265721229
Name:MASON, DEENA K (MED)
Entity type:Individual
Prefix:
First Name:DEENA
Middle Name:K
Last Name:MASON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:DEENA
Other - Middle Name:K
Other - Last Name:BOSSERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:ZILLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98953-0415
Mailing Address - Country:US
Mailing Address - Phone:509-961-9702
Mailing Address - Fax:509-248-3680
Practice Address - Street 1:307 S 12TH AVE STE 18
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3147
Practice Address - Country:US
Practice Address - Phone:509-961-9702
Practice Address - Fax:509-248-3680
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010083101Y00000X
WALH 00010083101YM0800X, 101YP2500X, 101YS0200X, 102L00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist