Provider Demographics
NPI:1780187732
Name:LANDRY, HALEY
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12721 MORGAN MEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-5104
Mailing Address - Country:US
Mailing Address - Phone:225-281-4120
Mailing Address - Fax:
Practice Address - Street 1:12721 MORGAN MEADOW AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-5104
Practice Address - Country:US
Practice Address - Phone:225-281-4120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
LA209181163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician