Provider Demographics
NPI:1962863530
Name:MASON-MORRIS, VANTAZIA MARTICE (BGS)
Entity Type:Individual
Prefix:
First Name:VANTAZIA
Middle Name:MARTICE
Last Name:MASON-MORRIS
Suffix:
Gender:F
Credentials:BGS
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 1:2002 GUS KAPLAN DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3358
Practice Address - Country:US
Practice Address - Phone:318-542-4642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator