Provider Demographics
NPI:1649712175
Name:LANDRY, DYMPHNA (LPC)
Entity type:Individual
Prefix:
First Name:DYMPHNA
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 DAGGS ST
Mailing Address - Street 2:
Mailing Address - City:BELLE ROSE
Mailing Address - State:LA
Mailing Address - Zip Code:70341-5632
Mailing Address - Country:US
Mailing Address - Phone:985-713-1317
Mailing Address - Fax:
Practice Address - Street 1:108 DAGGS ST
Practice Address - Street 2:
Practice Address - City:BELLE ROSE
Practice Address - State:LA
Practice Address - Zip Code:70341-5632
Practice Address - Country:US
Practice Address - Phone:985-713-1317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5566101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional