Basic Information
| Provider Information | |||||||||
| NPI: | 1265721229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASON | ||||||||
| FirstName: | DEENA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.ED | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BOSSERT | ||||||||
| OtherFirstName: | DEENA | ||||||||
| OtherMiddleName: | K | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.ED | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 415 | ||||||||
| Address2: | |||||||||
| City: | ZILLAH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989530415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099619702 | ||||||||
| FaxNumber: | 5092483680 | ||||||||
| Practice Location | |||||||||
| Address1: | 307 S 12TH AVE STE 18 | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099619702 | ||||||||
| FaxNumber: | 5092483680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2011 | ||||||||
| LastUpdateDate: | 03/30/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| ParentOrganizationLBN: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | LH00010083 | WA | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | LH 00010083 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | LH 00010083 | WA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YS0200X | LH 00010083 | WA | N | Behavioral Health & Social Service Providers | Counselor | School | 102L00000X | LH 00010083 | WA | N | Behavioral Health & Social Service Providers | Psychoanalyst | 106H00000X | LH 00010083 | WA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.