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NPI Code Detail

MEDICARE: MAZIE MARTISIUS LPC

MEDICARE: MAZIE MARTISIUS LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor7534LA

General Provider Information

NPI Number : 1477262111
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAZIE MARTISIUS LPC
Provider Business Mailing Address
First Line : 2000 MYRTLE AVE
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-6722
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2000 MYRTLE AVE
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-6722
Country : US
Telephone Number : 318-372-4210
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2022
Last Update Date : 11/22/2022

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Directions to “ MAZIE MARTISIUS LPC” Practice Location

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