Provider Demographics
NPI:1053661215
Name:LANDRY, KATHLEEN (LCMHC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 166
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:VT
Mailing Address - Zip Code:05648-0166
Mailing Address - Country:US
Mailing Address - Phone:802-472-5811
Mailing Address - Fax:
Practice Address - Street 1:132 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05843
Practice Address - Country:US
Practice Address - Phone:802-472-5811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0084086101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health