Provider Demographics
NPI:1164110193
Name:LANDRY, ALYSSA (LMFT, LMHC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:LMFT, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 N DONNELLY ST STE 7
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-4835
Mailing Address - Country:US
Mailing Address - Phone:321-209-2049
Mailing Address - Fax:
Practice Address - Street 1:851 N DONNELLY ST STE 7
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-4835
Practice Address - Country:US
Practice Address - Phone:321-209-2049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health