Provider Demographics
NPI:1962863530
Name:MASON-MORRIS, VANTAZIA MARTICE (MS, PLPC)
Entity type:Individual
Prefix:
First Name:VANTAZIA
Middle Name:MARTICE
Last Name:MASON-MORRIS
Suffix:
Gender:F
Credentials:MS, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 GUS KAPLAN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3358
Mailing Address - Country:US
Mailing Address - Phone:318-542-4642
Mailing Address - Fax:
Practice Address - Street 1:313 ACADIAN LAKE DR
Practice Address - Street 2:
Practice Address - City:DUSON
Practice Address - State:LA
Practice Address - Zip Code:70529-4364
Practice Address - Country:US
Practice Address - Phone:318-790-9953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC10493101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional