Provider Demographics
NPI:1396573895
Name:LANDRY COUNSELING AND SUPERVISION SERVICES, PLLC
Entity type:Organization
Organization Name:LANDRY COUNSELING AND SUPERVISION SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCMHC
Authorized Official - Phone:802-793-9850
Mailing Address - Street 1:760 KENT HILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST CALAIS
Mailing Address - State:VT
Mailing Address - Zip Code:05650-8048
Mailing Address - Country:US
Mailing Address - Phone:802-793-9850
Mailing Address - Fax:
Practice Address - Street 1:760 KENT HILL RD
Practice Address - Street 2:
Practice Address - City:EAST CALAIS
Practice Address - State:VT
Practice Address - Zip Code:05650-8048
Practice Address - Country:US
Practice Address - Phone:802-793-9850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1021075OtherVERMONT MEDICAID PROVIDER ID
12443277OtherCAQH CLEARINGHOUSE
VT3019214OtherMVP PROVIDER ID