Provider Demographics
NPI:1710480942
Name:LANDES, QUINN LEMOYNE (LMHC)
Entity Type:Individual
Prefix:MR
First Name:QUINN
Middle Name:LEMOYNE
Last Name:LANDES
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-5646
Mailing Address - Country:US
Mailing Address - Phone:407-875-3700
Mailing Address - Fax:
Practice Address - Street 1:1800 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7012
Practice Address - Country:US
Practice Address - Phone:407-843-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17888101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101YA0400XMedicaid