Doctor Name: | MR. TY CHRISTOPHER LANDRY |
NPI Number: | 1043404569 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 15628 |
Business Practice Address: | 15512 Miss Adriennes Path Pflugerville, TX - 786603282 |
Business Phone Number: | 5122527835 |
Business Fax Number: | |
Mailing Address: | 15512 Miss Adriennes Path, PFLUGERVILLE |
State: | TX |
Postal Code: | 786603282 |
Phone Number: | 5122527835 |
Fax Number: | |
NPI Enumeration Date: | 08/28/2007 |
NPI Last Update Date: | 08/28/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 15628 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |