Healthcare Provider Details

I. General information

NPI: 1962863530
Provider Name (Legal Business Name): VANTAZIA MARTICE MASON-MORRIS MS, PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 ACADIAN LAKE DR
DUSON LA
70529-4364
US

IV. Provider business mailing address

2002 GUS KAPLAN DR
ALEXANDRIA LA
71301-3358
US

V. Phone/Fax

Practice location:
  • Phone: 318-790-9953
  • Fax:
Mailing address:
  • Phone: 318-542-4642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPLC10493
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC10493
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: