Individual
TICA MASON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN,BSN
Contact information
Practice address
6302 E QUARTZ ST, MESA, AZ 85215-0943
(480) 862-3643
Mailing address
1343 N 26TH ST, MESA, AZ 85213-4111
(480) 862-3643
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH10019
AZ
Other
Enumeration date
10/03/2024
Last updated
10/03/2024
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