Active NPI
Athena Mask, MT-BC
- Music Therapist
- Longview, TX
National Provider Identifier
1952935454
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Music Therapist
- License
- 14101
- Practice address
- 2455 N Eastman Rd
Longview, TX 75605-4057 - Phone
- (903) 315-9338
- NPI assigned
- Feb 24, 2020
- Last updated
- Feb 24, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Music Therapist | 225A00000X | 14101 | TX | Primary |
Addresses
Primary practice location
2455 N Eastman Rd
Longview, TX 75605-4057
Mailing address
408 E South St Apt 2
Kilgore, TX 75662-2552
Phone (903) 315-9338
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14101 | TX | MD | Music Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582502400000",
"number": "1952935454",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "408 E SOUTH ST APT 2",
"city": "KILGORE",
"state": "TX",
"postal_code": "756622552",
"telephone_number": "903-315-9338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2455 N EASTMAN RD",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756054057",
"telephone_number": "903-315-9338"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASK",
"first_name": "ATHENA",
"credential": "MT-BC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-02-24",
"last_updated": "2020-02-24",
"certification_date": "2020-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "225A00000X",
"taxonomy_group": "",
"desc": "Music Therapist",
"state": "TX",
"license": "14101",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.