Healthcare Provider Details

I. General information

NPI: 1396573895
Provider Name (Legal Business Name): LANDRY COUNSELING AND SUPERVISION SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 KENT HILL RD
EAST CALAIS VT
05650-8048
US

IV. Provider business mailing address

760 KENT HILL RD
EAST CALAIS VT
05650-8048
US

V. Phone/Fax

Practice location:
  • Phone: 802-793-9850
  • Fax:
Mailing address:
  • Phone: 802-793-9850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KATHLEEN MARIE LANDRY
Title or Position: OWNER/ CLINICAL DIRECTOR
Credential: MA, LCMHC
Phone: 802-793-9850