Provider Demographics
NPI:1326423039
Name:HALL-LANDRY, MAMIE (LPC)
Entity Type:Individual
Prefix:
First Name:MAMIE
Middle Name:
Last Name:HALL-LANDRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 SAN SABA CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-9726
Mailing Address - Country:US
Mailing Address - Phone:504-458-6279
Mailing Address - Fax:
Practice Address - Street 1:5505 SAN SABA CT
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-9726
Practice Address - Country:US
Practice Address - Phone:504-458-6279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78718101YM0800X
LA3973101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health