Provider Demographics
NPI:1770898181
Name:MASON, LEE LANDRUM (PHD; BCBA-D)
Entity type:Individual
Prefix:PROF
First Name:LEE
Middle Name:LANDRUM
Last Name:MASON
Suffix:
Gender:M
Credentials:PHD; BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UTSA CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1644
Mailing Address - Country:US
Mailing Address - Phone:210-458-4524
Mailing Address - Fax:210-458-7281
Practice Address - Street 1:501 W CESAR E CHAVEZ BLVD
Practice Address - Street 2:DB 0.220
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-4415
Practice Address - Country:US
Practice Address - Phone:210-458-2007
Practice Address - Fax:210-458-7281
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-07-3606103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst