Provider Demographics
NPI:1801819032
Name:LANDIS, TIMOTHY ALAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ALAN
Last Name:LANDIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 28 RD
Mailing Address - Street 2:SUITE A207
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6556
Mailing Address - Country:US
Mailing Address - Phone:970-412-6060
Mailing Address - Fax:970-245-3216
Practice Address - Street 1:518 28 RD
Practice Address - Street 2:SUITE A207
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6556
Practice Address - Country:US
Practice Address - Phone:970-412-6060
Practice Address - Fax:970-245-3216
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9896791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical