Provider Demographics
NPI:1487288775
Name:MASON, DARCY (LPC-IT, SAC-IT)
Entity type:Individual
Prefix:
First Name:DARCY
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:LPC-IT, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8825 S HOWELL AVE # 200
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-3760
Mailing Address - Country:US
Mailing Address - Phone:414-215-7554
Mailing Address - Fax:414-215-7644
Practice Address - Street 1:8825 S HOWELL AVE # 200
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-3760
Practice Address - Country:US
Practice Address - Phone:414-215-7554
Practice Address - Fax:414-215-7644
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4317-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health