Provider Demographics
NPI:1841363827
Name:LANDAU, DENISE (PHD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:LANDAU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 341104
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38184-1104
Mailing Address - Country:US
Mailing Address - Phone:901-652-5344
Mailing Address - Fax:888-418-6339
Practice Address - Street 1:4646 POPLAR AVE STE 217
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4432
Practice Address - Country:US
Practice Address - Phone:901-652-5344
Practice Address - Fax:888-418-6339
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1212103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3071776OtherBLUE CROSS BLUE SHIELD
TN3071776OtherBLUE CROSS BLUE SHIELD