Organization
PINE RIDGE MENTAL HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLE MASON PA (OWNER)
(618) 781-8686
Entity
Organization
Contact information
Practice address
8418 N 123RD EAST AVE, OWASSO, OK 74055-2139
(918) 858-4353
Mailing address
8418 N 123RD EAST AVE, OWASSO, OK 74055-2139
(918) 858-4353
(866) 246-2942
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
—
164W00000X
Licensed Practical Nurse
—
—
207Q00000X
Family Medicine Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
376K00000X
Nurse's Aide
—
—
Other
Enumeration date
04/01/2021
Last updated
04/06/2026
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