Provider Demographics
NPI:1073271219
Name:LANDOR, GRISELDA (LMFT- ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:GRISELDA
Middle Name:
Last Name:LANDOR
Suffix:
Gender:F
Credentials:LMFT- ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 FM 423 APT 8305
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75036-7164
Mailing Address - Country:US
Mailing Address - Phone:832-503-0284
Mailing Address - Fax:
Practice Address - Street 1:5050 FM 423 APT 8305
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036-7164
Practice Address - Country:US
Practice Address - Phone:832-503-0284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204220106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist