Healthcare Provider Details

I. General information

NPI: 1669385530
Provider Name (Legal Business Name): LANDRY DIANE CANFIELD T-LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 S CLAIRBORNE RD STE B
OLATHE KS
66062-4108
US

IV. Provider business mailing address

22610 S HARRISON ST APT 1206
SPRING HILL KS
66083-3157
US

V. Phone/Fax

Practice location:
  • Phone: 913-324-5017
  • Fax:
Mailing address:
  • Phone: 620-794-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number05561-T
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: