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: |