Provider Demographics
NPI:1760718571
Name:DORIS A. LANDRY, M.S., P.C.
Entity Type:Organization
Organization Name:DORIS A. LANDRY, M.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANDRY-KRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LLP
Authorized Official - Phone:248-891-8139
Mailing Address - Street 1:1894 MAJON
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48356-1757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34441 8 MILE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4013
Practice Address - Country:US
Practice Address - Phone:248-891-8139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007803251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management