Provider Demographics
NPI:1811700867
Name:MASON, TYREECE LATRELL
Entity type:Individual
Prefix:
First Name:TYREECE
Middle Name:LATRELL
Last Name:MASON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8351 WHIPPORWILL DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-6639
Mailing Address - Country:US
Mailing Address - Phone:317-341-4660
Mailing Address - Fax:
Practice Address - Street 1:8351 WHIPPORWILL DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-6639
Practice Address - Country:US
Practice Address - Phone:317-341-4660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician