Provider Demographics
NPI:1265949135
Name:MASON, ANTRON DONTRELL SR
Entity type:Individual
Prefix:
First Name:ANTRON
Middle Name:DONTRELL
Last Name:MASON
Suffix:SR
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 1:60 BAYOU VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2732
Mailing Address - Country:US
Mailing Address - Phone:318-235-3518
Mailing Address - Fax:318-235-3518
Practice Address - Street 1:60 BAYOU VIEW DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2732
Practice Address - Country:US
Practice Address - Phone:318-235-3518
Practice Address - Fax:318-235-3518
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health