MEDICARE: VANTAZIA MARTICE MASON-MORRIS MS, PLPC

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	101YP2500X	Professional Counselor	PLC10493	LA
2	101YM0800X	Mental Health Counselor	PLC10493	LA

General Provider Information

NPI Number	:	1962863530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANTAZIA MARTICE MASON-MORRIS MS, PLPC

Provider Business Mailing Address
First Line	:	2002 GUS KAPLAN DR
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3358
Country	:	US
Telephone Number	:	318-542-4642
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 ACADIAN LAKE DR
Second Line	:
City	:	DUSON
State	:	LA
Zip	:	70529-4364
Country	:	US
Telephone Number	:	318-790-9953
Fax Number	:

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

Provider Enumeration Date	:	03/10/2016
Last Update Date	:	01/06/2025

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