Provider Demographics
NPI:1861829673
Name:LANDRY, JULIE ANN (LCSW, BACS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:LANDRY
Suffix:
Gender:F
Credentials:LCSW, BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3122 JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-2930
Mailing Address - Country:US
Mailing Address - Phone:504-481-9464
Mailing Address - Fax:
Practice Address - Street 1:3122 JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-2930
Practice Address - Country:US
Practice Address - Phone:504-481-9464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3501-BACS1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical