Provider Demographics
NPI:1952595381
Name:DAYSPRING COUNSELING CENTER
Entity Type:Organization
Organization Name:DAYSPRING COUNSELING CENTER
Other - Org Name:GARY LANDIS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:DANE
Authorized Official - Last Name:LANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, CADC, QMHP
Authorized Official - Phone:270-299-2262
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42782-0157
Mailing Address - Country:US
Mailing Address - Phone:270-299-2262
Mailing Address - Fax:270-299-2264
Practice Address - Street 1:2673 CAMPBELLSVILLE RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-9703
Practice Address - Country:US
Practice Address - Phone:270-299-2262
Practice Address - Fax:270-299-2264
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARY LANDIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0485261QM0801X, 261QM0850X, 261QM0855X
KY0436261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder