MEDICARE: CHANTEL B LANDEROS LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFT.0002042	CO

General Provider Information

NPI Number	:	1952757908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANTEL B LANDEROS LMFT

Provider Business Mailing Address
First Line	:	715 HORIZON DR STE 225
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-8743
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2526 PATTERSON RD UNIT 200
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1146
Country	:	US
Telephone Number	:	970-812-1292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2016
Last Update Date	:	09/20/2022

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