Provider Demographics
NPI:1447736160
Name:LANDIS, LAURA GRACE (MED, LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:GRACE
Last Name:LANDIS
Suffix:
Gender:F
Credentials:MED, LPC-S
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:GRACE
Other - Last Name:HAMMACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:205 KING AVE
Mailing Address - Street 2:
Mailing Address - City:HOWE
Mailing Address - State:TX
Mailing Address - Zip Code:75459-4559
Mailing Address - Country:US
Mailing Address - Phone:254-216-0124
Mailing Address - Fax:
Practice Address - Street 1:205 KING AVE
Practice Address - Street 2:
Practice Address - City:HOWE
Practice Address - State:TX
Practice Address - Zip Code:75459-4559
Practice Address - Country:US
Practice Address - Phone:254-216-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65766101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional