Individual
MIKKI K MASON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT, LADC
Contact information
Practice address
9245 QUANTRELLE AVE NE, OTSEGO, MN 55330-0168
(763) 308-8619
Mailing address
5645 GREEN CIRCLE DR APT 200, MINNETONKA, MN 55343-9658
(612) 532-1020
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
304777
MN
106H00000X
Marriage & Family Therapist
Primary
4150
MN
Other
Enumeration date
10/11/2021
Last updated
10/11/2021
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