Provider Demographics
NPI:1265995484
Name:DR. DAVID LANDRY, PH.D., LLC
Entity type:Organization
Organization Name:DR. DAVID LANDRY, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:337-374-1952
Mailing Address - Street 1:203 W MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3795
Mailing Address - Country:US
Mailing Address - Phone:337-374-1952
Mailing Address - Fax:337-205-6171
Practice Address - Street 1:203 W MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3795
Practice Address - Country:US
Practice Address - Phone:337-374-1952
Practice Address - Fax:337-205-6171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-14
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty