Healthcare Provider Details

I. General information

NPI: 1396267233
Provider Name (Legal Business Name): ANGELA LANDRY, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5687 COMMERCE STREET SUITE 7
ST. FRANCISVILLE LA
70775
US

IV. Provider business mailing address

PO BOX 2162
SAINT FRANCISVILLE LA
70775-2162
US

V. Phone/Fax

Practice location:
  • Phone: 225-245-5040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number11067
License Number StateLA

VIII. Authorized Official

Name: ANGELA LANDRY
Title or Position: OWNER
Credential: LCSW
Phone: 225-718-9525