Provider Demographics
NPI:1295920296
Name:MASON, BRIAN O (LCSW, LMSW)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:O
Last Name:MASON
Suffix:
Gender:M
Credentials:LCSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 PENTECOST HWY
Mailing Address - Street 2:
Mailing Address - City:ONSTED
Mailing Address - State:MI
Mailing Address - Zip Code:49265-9638
Mailing Address - Country:US
Mailing Address - Phone:815-245-6834
Mailing Address - Fax:
Practice Address - Street 1:214 PENTECOST HWY
Practice Address - Street 2:
Practice Address - City:ONSTED
Practice Address - State:MI
Practice Address - Zip Code:49265-9638
Practice Address - Country:US
Practice Address - Phone:815-245-6834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011191631041C0700X
IL1490077511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149007751OtherLICENSED CLINICAL SOCIAL WORKER