Provider Demographics
NPI:1154863504
Name:LANDERS, MICHAEL (MDIV)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LANDERS
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15420 DESIREE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3515
Mailing Address - Country:US
Mailing Address - Phone:949-241-0813
Mailing Address - Fax:
Practice Address - Street 1:15420 DESIREE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-3515
Practice Address - Country:US
Practice Address - Phone:949-241-0813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health