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General NPI Number Information
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NPI Number | 1154989671
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Entity Type | Organization
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Legal Business Name | LANDING MEADOWS MENTAL HEALTH COUNSELING PLLC
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Dates
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Enumeration Date | 05/30/2019
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Last Update Date | 05/30/2019
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Provider Practice Location Address
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Address Line | 900 WALT WHITMAN ROAD SUITE LL 4
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City | MELVILLE
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State | NY
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Zip | 11747
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Country | US
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Telephone | 631-350-2719
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Fax | 631-350-2725
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Provider Business Mailing Address
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Address Line | 101 CLINTON AVE APT 1A
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City | MINEOLA
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State | NY
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Zip | 11501-2848
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Country | US
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Telephone | 516-408-0200
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. SHAUN DIETERICH
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Credential | LMHC
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Telephone | 516-408-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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