Provider Information for 1205379278
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ERIC C MASON CSW-Intern
Sex: Male
NPI: 1205379278
Last Updated: 2016-11-23
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||||
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| NPI | 1205379278 | ||||||||||||||||
| Enumeration Date | 2016-11-23 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 6300 PORTOLA RD LAS VEGAS, NV 89108-3921 United States Phone: 702-686-1484 | Fax:702-445-6534 | ||||||||||||||||
| Primary Practice Address | 6300 PORTOLA RD LAS VEGAS, NV 89108-3921 United States Phone: 702-686-1484 | Fax:702-445-6534 | ||||||||||||||||
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