Provider Demographics
NPI:1528543451
Name:LANDRY, RYAN PAUL
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:PAUL
Last Name:LANDRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 RIDGELAKE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4959
Mailing Address - Country:US
Mailing Address - Phone:504-581-4333
Mailing Address - Fax:
Practice Address - Street 1:3200 RIDGELAKE DR STE 100
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4959
Practice Address - Country:US
Practice Address - Phone:504-581-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health