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General NPI Number Information
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NPI Number | 1962863530
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Entity Type | Individual
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Provider Name | VANTAZIA MARTICE MASON-MORRIS MS, PLPC
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Gender | Female
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Dates
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Enumeration Date | 03/10/2016
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 313 ACADIAN LAKE DR
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City | DUSON
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State | LA
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Zip | 70529-4364
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Country | US
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Telephone | 318-790-9953
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Fax |
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Provider Business Mailing Address
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Address Line | 2002 GUS KAPLAN DR
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3358
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Country | US
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Telephone | 318-542-4642
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PLC10493
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PLC10493
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License Number State | LA
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