Provider Demographics
NPI:1376721837
Name:LANDIS, ELLEN M (LMFT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:LANDIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3444
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01004-3444
Mailing Address - Country:US
Mailing Address - Phone:413-586-5800
Mailing Address - Fax:413-253-1751
Practice Address - Street 1:217 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-9521
Practice Address - Country:US
Practice Address - Phone:413-586-5800
Practice Address - Fax:413-253-1751
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA813106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist