Provider Demographics
NPI:1669202347
Name:MAZUR, NICOLE (MAC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MAZUR
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 FERN AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4974
Mailing Address - Country:US
Mailing Address - Phone:318-218-1075
Mailing Address - Fax:
Practice Address - Street 1:7330 FERN AVE STE 303
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4974
Practice Address - Country:US
Practice Address - Phone:318-218-1075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor