Provider Demographics
NPI:1669084661
Name:MASON, ADRIANNE (CMHC)
Entity type:Individual
Prefix:
First Name:ADRIANNE
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 N HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GENOLA
Mailing Address - State:UT
Mailing Address - Zip Code:84655-5066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1580 N HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:GENOLA
Practice Address - State:UT
Practice Address - Zip Code:84655-5066
Practice Address - Country:US
Practice Address - Phone:801-360-3852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6149552-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional