Provider Demographics
NPI:1770102733
Name:MASON, JANNA MARIE (MS, LPCC, NCC)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:MARIE
Last Name:MASON
Suffix:
Gender:F
Credentials:MS, LPCC, NCC
Other - Prefix:
Other - First Name:JANNA
Other - Middle Name:MARIE
Other - Last Name:SCHRIBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPCC, NCC
Mailing Address - Street 1:12800 WHITEWATER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9347
Mailing Address - Country:US
Mailing Address - Phone:307-689-1818
Mailing Address - Fax:
Practice Address - Street 1:12800 WHITEWATER DR STE 100
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9347
Practice Address - Country:US
Practice Address - Phone:612-562-6605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-62412101YP2500X
MN2441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional