Healthcare Provider Details

I. General information

NPI: 1639711005
Provider Name (Legal Business Name): DANIELLE D LANDA LAMFT, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 E RIVER RD STE 1
ANOKA MN
55303-1891
US

IV. Provider business mailing address

646 E RIVER RD STE 1
ANOKA MN
55303-1891
US

V. Phone/Fax

Practice location:
  • Phone: 763-427-1950
  • Fax: 763-427-7006
Mailing address:
  • Phone: 763-427-1950
  • Fax: 763-427-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: