Healthcare Provider Details

I. General information

NPI: 1528977089
Provider Name (Legal Business Name): CAROL C LANDRY MA., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 KALISTE SALOOM RD
LAFAYETTE LA
70508-7449
US

IV. Provider business mailing address

3312 KALISTE SALOOM RD
LAFAYETTE LA
70508-7449
US

V. Phone/Fax

Practice location:
  • Phone: 337-237-0788
  • Fax: 888-216-1252
Mailing address:
  • Phone: 337-237-0788
  • Fax: 888-216-1252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2049
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: