Provider Demographics
NPI:1013047067
Name:LANDIS, SHERYL (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:
Last Name:LANDIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-5778
Mailing Address - Country:US
Mailing Address - Phone:765-674-2208
Mailing Address - Fax:674-674-3273
Practice Address - Street 1:5230 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-5778
Practice Address - Country:US
Practice Address - Phone:765-674-2208
Practice Address - Fax:674-674-3273
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000613A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN249811000OtherMAGELLAN
IN000000175679OtherBLUE CROSS BLUE SHIELD
IN7003686OtherAETNA