Provider Demographics
NPI:1134636343
Name:LANDRY, THETA (OFFICE MANAGER)
Entity Type:Individual
Prefix:
First Name:THETA
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:OFFICE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10431 SIEGEN LN STE 101
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-4984
Mailing Address - Country:US
Mailing Address - Phone:225-960-7179
Mailing Address - Fax:
Practice Address - Street 1:10431 SIEGEN LN STE 101
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-4984
Practice Address - Country:US
Practice Address - Phone:225-960-7179
Practice Address - Fax:225-960-7185
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health