Provider Demographics
NPI:1659865145
Name:LANDRY THERAPY GROUP PLLC
Entity Type:Organization
Organization Name:LANDRY THERAPY GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:214-306-4898
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-0222
Mailing Address - Country:US
Mailing Address - Phone:214-306-4898
Mailing Address - Fax:
Practice Address - Street 1:750 N FIELDER RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4635
Practice Address - Country:US
Practice Address - Phone:214-306-4898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00688BOtherBLUE CROSS BLUE SHIELD OF TEXAS