Provider Demographics
NPI:1952985384
Name:LANDIS, LAWRA
Entity Type:Individual
Prefix:
First Name:LAWRA
Middle Name:
Last Name:LANDIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3376 S EASTERN AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3388
Mailing Address - Country:US
Mailing Address - Phone:702-490-9009
Mailing Address - Fax:866-737-6147
Practice Address - Street 1:9089 S PECOS RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7183
Practice Address - Country:US
Practice Address - Phone:702-680-1526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician