Provider Demographics
NPI:1902438195
Name:MASON, JABRIELLE (RBT, LMSW)
Entity Type:Individual
Prefix:MS
First Name:JABRIELLE
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:RBT, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 MAIN ST STE 119
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4336
Mailing Address - Country:US
Mailing Address - Phone:317-518-4405
Mailing Address - Fax:346-566-4805
Practice Address - Street 1:2770 MAIN ST STE 119
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4336
Practice Address - Country:US
Practice Address - Phone:317-518-4405
Practice Address - Fax:346-566-4805
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TX67595104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1538871082OtherESSENTIAL COUNSELING GROUP