Provider Demographics
NPI:1518566736
Name:LANDON-FREEMAN CENTER FOR ANXIETY, RECOVERY AND TRAUMA LLC
Entity Type:Organization
Organization Name:LANDON-FREEMAN CENTER FOR ANXIETY, RECOVERY AND TRAUMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDON-FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:267-270-2340
Mailing Address - Street 1:1650 LIMEKILN PIKE STE B19
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1503
Mailing Address - Country:US
Mailing Address - Phone:267-270-2340
Mailing Address - Fax:
Practice Address - Street 1:1650 LIMEKILN PIKE STE B19
Practice Address - Street 2:
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19025-1503
Practice Address - Country:US
Practice Address - Phone:267-270-2340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty