Provider Demographics
NPI:1942023254
Name:MASON, KAITLIN (RBT)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18521 E QUEEN CREEK RD STE 105-627
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5870
Mailing Address - Country:US
Mailing Address - Phone:480-361-1025
Mailing Address - Fax:480-814-7488
Practice Address - Street 1:18521 E QUEEN CREEK RD STE 105-627
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5870
Practice Address - Country:US
Practice Address - Phone:480-361-1025
Practice Address - Fax:480-814-7488
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRBT-24-390547106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician