Healthcare Provider Details

I. General information

NPI: 1760153589
Provider Name (Legal Business Name): KRYSTLE DAWN LANDES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 BARTERBROOK RD
STAUNTON VA
24401-5560
US

IV. Provider business mailing address

1455 BARTERBROOK RD
STAUNTON VA
24401-5560
US

V. Phone/Fax

Practice location:
  • Phone: 540-324-8829
  • Fax:
Mailing address:
  • Phone: 540-324-8829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number87082
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701010349
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: