Provider Demographics
NPI:1265926927
Name:MASON, JATARA LATOI (LMHC)
Entity type:Individual
Prefix:MS
First Name:JATARA
Middle Name:LATOI
Last Name:MASON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 CLEMATIS ST # 3853
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5306
Mailing Address - Country:US
Mailing Address - Phone:561-543-3783
Mailing Address - Fax:
Practice Address - Street 1:1546 40TH ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3638
Practice Address - Country:US
Practice Address - Phone:561-543-3783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16019101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health