Provider Demographics
NPI:1740762848
Name:MASSON, JESSE (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:
Last Name:MASSON
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 S EASTGATE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-2146
Mailing Address - Country:US
Mailing Address - Phone:417-708-8813
Mailing Address - Fax:
Practice Address - Street 1:2131 S EASTGATE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65809-2146
Practice Address - Country:US
Practice Address - Phone:855-593-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2695101YP2500X
MO2017038401101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional