Provider Demographics
NPI:1801055918
Name:MASON, PHYLLIS ANN (MSW)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:ANN
Last Name:MASON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8230 N KY 11
Mailing Address - Street 2:
Mailing Address - City:GREEN ROAD
Mailing Address - State:KY
Mailing Address - Zip Code:40946-6505
Mailing Address - Country:US
Mailing Address - Phone:606-546-9421
Mailing Address - Fax:606-546-6951
Practice Address - Street 1:8230 N KY 11
Practice Address - Street 2:
Practice Address - City:GREEN ROAD
Practice Address - State:KY
Practice Address - Zip Code:40946-6505
Practice Address - Country:US
Practice Address - Phone:606-546-9421
Practice Address - Fax:606-546-6951
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator