Individual provider Active NPI

Christine E Mason, PHD

  • Clinical Psychologist
  • Marietta, GA
National Provider Identifier
1063729390
Registry record updated Jul 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY004377 Issued in GA
Practice address
175 White St NW Ste 100
Marietta, GA 30060-1054
Phone
(470) 793-0200
NPI assigned
Sep 8, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 2, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY004377 GA Primary
Mental Health Counselor 101YM0800X 12571 CO

Addresses

Primary practice location

175 White St NW Ste 100
Marietta, GA 30060-1054

Mailing address

805 Sandy Plains Road
Medical Staff Services
Marietta, GA 30066-6340

Other practice location 1

5500 S Sycamore St
Littleton, CO 80120-8201
Phone (303) 797-9440

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cmason372705@directwellstar.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
12571COMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Drlullaby LLC CurrentSince May 1, 2022 Accepting new patients
Drlullaby LLC CurrentSince May 1, 2022 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1283904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593648000000",
    "number": "1063729390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 SANDY PLAINS ROAD",
            "address_2": "MEDICAL STAFF SERVICES",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300666340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 WHITE ST NW STE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601054",
            "telephone_number": "470-793-0200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5500 S Sycamore St",
            "address_purpose": "LOCATION",
            "city": "Littleton",
            "state": "CO",
            "postal_code": "801208201",
            "country_code": "US",
            "telephone_number": "303-797-9440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MASON",
        "first_name": "CHRISTINE",
        "middle_name": "E",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-09-08",
        "last_updated": "2020-07-02",
        "certification_date": "2020-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY004377",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CO",
            "license": "12571",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cmason372705@directwellstar.org",
            "affiliation": "N",
            "address_1": "175 White St NW Ste 100",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300601054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.