Healthcare Provider Details

I. General information

NPI: 1679088843
Provider Name (Legal Business Name): NATALIE LANDRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2017
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7865 JEFFERSON HWY
BATON ROUGE LA
70809-1384
US

IV. Provider business mailing address

3535 APOLLO DR APT 155P
METAIRIE LA
70003-3317
US

V. Phone/Fax

Practice location:
  • Phone: 225-250-7940
  • Fax:
Mailing address:
  • Phone: 504-402-0072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12788
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12788
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: