Most Relevant Information
Provider Data
| NPI Number: | 1003578758 |
| Provider Name: | MIKKI K MASON LMFT, LADC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 304777 |
Most Important Dates
| Enumeration Date: | 10/11/2021 |
| Last Updated: | 10/11/2021 |
Provider Practice Location
9245 QUANTRELLE AVE NE
OTSEGO
MN
553300168
Practice Location Phone/Fax
| Phone: | 7633088619 |
| Fax: |
Provider Mailing Location
5645 GREEN CIRCLE DR APT 200
MINNETONKA
MN
553439658
Provider Mailing Phone/Fax
| Phone: | 6125321020 |
| Fax: |