Healthcare Provider Details

I. General information

NPI: 1184852857
Provider Name (Legal Business Name): DAVID D. LANDERS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S CAPITAL OF TEXAS HWY BLDG C, SUITE 130
WEST LAKE HILLS TX
78746-6574
US

IV. Provider business mailing address

PO BOX 93066
AUSTIN TX
78709-3066
US

V. Phone/Fax

Practice location:
  • Phone: 512-779-6394
  • Fax:
Mailing address:
  • Phone: 512-779-6394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34013
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number34013
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: