Provider Demographics
NPI:1841321304
Name:MASON, LARK R (LSCSW)
Entity type:Individual
Prefix:
First Name:LARK
Middle Name:R
Last Name:MASON
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 SHAWNEE MISSION PKWY STE 218
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202-4073
Mailing Address - Country:US
Mailing Address - Phone:913-432-9115
Mailing Address - Fax:913-432-2484
Practice Address - Street 1:6811 SHAWNEE MISSION PKWY STE 218
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202-4073
Practice Address - Country:US
Practice Address - Phone:913-432-9115
Practice Address - Fax:913-432-2484
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSL.S.C.S.W. 11501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical