Basic Information
| Provider Information | |||||||||
| NPI: | 1376550087 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASON | ||||||||
| FirstName: | HELEN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2043 MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | NEWBERRY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291082249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032768000 | ||||||||
| FaxNumber: | 8032766669 | ||||||||
| Practice Location | |||||||||
| Address1: | 2043 MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | NEWBERRY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291082249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032768000 | ||||||||
| FaxNumber: | 8032766669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 03/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 4825 | SC | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 421504 | 05 | SC | MEDICAID |