Provider Demographics
NPI:1265703615
Name:LANDES, JOAN R (CMHC)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:R
Last Name:LANDES
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:MRS
Other - First Name:JOAN
Other - Middle Name:R
Other - Last Name:LANDES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CMHC
Mailing Address - Street 1:6148 W 8400 S
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-9736
Mailing Address - Country:US
Mailing Address - Phone:435-709-5788
Mailing Address - Fax:
Practice Address - Street 1:6148 W 8400 S
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-9736
Practice Address - Country:US
Practice Address - Phone:435-709-5788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8542770-6009101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor