Provider Demographics
NPI:1336389329
Name:MASON, LEWIS JONATHAN (MA)
Entity Type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:JONATHAN
Last Name:MASON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:L.
Other - Middle Name:JOHN
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1258 EAGLE CREST DR
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-8492
Mailing Address - Country:US
Mailing Address - Phone:360-593-3833
Mailing Address - Fax:
Practice Address - Street 1:1258 EAGLE CREST DR
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-8492
Practice Address - Country:US
Practice Address - Phone:360-593-3833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC 60072751101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health