Provider Demographics
NPI:1659360329
Name:LANDRUM, THELMA LOUISE (MC, PHD)
Entity Type:Individual
Prefix:DR
First Name:THELMA
Middle Name:LOUISE
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:MC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 S LAKESHORE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-8339
Mailing Address - Country:US
Mailing Address - Phone:480-775-0515
Mailing Address - Fax:480-775-0660
Practice Address - Street 1:4525 S LAKESHORE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-8339
Practice Address - Country:US
Practice Address - Phone:480-775-0515
Practice Address - Fax:480-775-0660
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AZLPC10714101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional