Individual
MR. ISACC JERMAYNE MASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
15 NW VILLAGE GREEN DR APT 232, LAWTON, OK 73505-5987
(580) 583-8788
Mailing address
15 NW VILLAGE GREEN DR APT 232, LAWTON, OK 73505
(580) 583-8788
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
N083011721
OK
Other
Enumeration date
03/13/2012
Last updated
03/13/2012
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