Provider Demographics
NPI:1700061405
Name:MASON, TAQUANA ZENO (LPN)
Entity Type:Individual
Prefix:MS
First Name:TAQUANA
Middle Name:ZENO
Last Name:MASON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2708
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70069-2708
Mailing Address - Country:US
Mailing Address - Phone:952-651-4612
Mailing Address - Fax:985-651-4613
Practice Address - Street 1:299 BELLE TERRE BLVD STE E
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-2425
Practice Address - Country:US
Practice Address - Phone:985-651-4612
Practice Address - Fax:985-651-4613
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-01
Last Update Date:2019-12-17
Deactivation Date:2019-08-29
Deactivation Code:
Reactivation Date:2019-10-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker