MEDICARE: DENISE MAZANT BS

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1629527973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE MAZANT BS

Provider Business Mailing Address
First Line	:	10001 LAKE FOREST BLVD
Second Line	:	600
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-6200
Country	:	US
Telephone Number	:	504-323-3440
Fax Number	:

Provider Business Practice Location Address
First Line	:	3443 ESPLANADE AVE
Second Line	:	SUITE 651
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-2916
Country	:	US
Telephone Number	:	505-975-6653
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2016
Last Update Date	:	09/28/2016

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