Provider Demographics
NPI:1457406522
Name:MASON, ANDREA E (LMHC)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:E
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 1:7850 ULMERTON RD STE 4
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4015
Mailing Address - Country:US
Mailing Address - Phone:727-542-3635
Mailing Address - Fax:727-213-9035
Practice Address - Street 1:7850 ULMERTON RD STE 4
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-4015
Practice Address - Country:US
Practice Address - Phone:727-542-3635
Practice Address - Fax:727-213-9035
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7842101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004684300Medicaid