Provider Demographics
NPI:1639235849
Name:LANDIS, TOBY Y (PHD)
Entity Type:Individual
Prefix:DR
First Name:TOBY
Middle Name:Y
Last Name:LANDIS
Suffix:
Gender:F
Credentials:PHD
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 875
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:CA
Mailing Address - Zip Code:95684-0875
Mailing Address - Country:US
Mailing Address - Phone:530-906-6955
Mailing Address - Fax:
Practice Address - Street 1:493 MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9173
Practice Address - Country:US
Practice Address - Phone:530-642-8205
Practice Address - Fax:530-620-3423
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12672103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical