Basic Information
Provider Information
NPI: 1457632267
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NOJONEN
FirstName: MASON
MiddleName: JOHN
NamePrefix: MR.
NameSuffix:  
Credential: M.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4851 INDEPENDENCE ST
Address2: SUITE 200
City: WHEAT RIDGE
State: CO
PostalCode: 800336715
CountryCode: US
TelephoneNumber: 3034250300
FaxNumber: 3034325071
Practice Location
Address1: 9485 W COLFAX AVE
Address2:  
City: LAKEWOOD
State: CO
PostalCode: 802153918
CountryCode: US
TelephoneNumber: 3034325200
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/07/2011
LastUpdateDate: 07/21/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/21/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  N Behavioral Health & Social Service ProvidersCounselorMental Health
171M00000X  Y Other Service ProvidersCase Manager/Care Coordinator 

No ID Information.


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