Provider Demographics
NPI:1659360642
Name:LANDIS, GARY (LMFT, CADC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:LANDIS
Suffix:
Gender:M
Credentials:LMFT, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CARDINAL DR
Mailing Address - Street 2:STE. 201
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3902
Mailing Address - Country:US
Mailing Address - Phone:270-769-3445
Mailing Address - Fax:
Practice Address - Street 1:800 CARDINAL DR
Practice Address - Street 2:STE. 201
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-3902
Practice Address - Country:US
Practice Address - Phone:270-769-3445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0436101YA0400X
KY0485106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist