Provider Demographics
NPI:1841940244
Name:LANDERS, MARY KATHRYN (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:LANDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CENTURY BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3787
Mailing Address - Country:US
Mailing Address - Phone:731-234-7056
Mailing Address - Fax:
Practice Address - Street 1:574 HERMITAGE TRAIL DR
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-1926
Practice Address - Country:US
Practice Address - Phone:731-234-7056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1066501041C0700X
TN62711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical