Provider Demographics
NPI:1043404569
Name:LANDRY, TY CHRISTOPHER (LPC)
Entity Type:Individual
Prefix:MR
First Name:TY
Middle Name:CHRISTOPHER
Last Name:LANDRY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15512 MISS ADRIENNES PATH
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3282
Mailing Address - Country:US
Mailing Address - Phone:512-252-7835
Mailing Address - Fax:
Practice Address - Street 1:15512 MISS ADRIENNES PATH
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3282
Practice Address - Country:US
Practice Address - Phone:512-252-7835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15628101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX28027301Medicaid