Provider Demographics
NPI:1518242304
Name:LANDIS, JULIA MARGARET (BS MS LPC)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MARGARET
Last Name:LANDIS
Suffix:
Gender:F
Credentials:BS MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W COUNTY ROAD 66
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-9620
Mailing Address - Country:US
Mailing Address - Phone:970-495-6976
Mailing Address - Fax:970-495-6975
Practice Address - Street 1:503 REMINGTON ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3074
Practice Address - Country:US
Practice Address - Phone:970-495-6976
Practice Address - Fax:970-495-6975
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1302101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional