Provider Demographics
NPI:1154989671
Name:LANDING MEADOWS MENTAL HEALTH COUNSELING PLLC
Entity type:Organization
Organization Name:LANDING MEADOWS MENTAL HEALTH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIETERICH
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:516-408-0200
Mailing Address - Street 1:101 CLINTON AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2848
Mailing Address - Country:US
Mailing Address - Phone:516-408-0200
Mailing Address - Fax:
Practice Address - Street 1:900 WALT WHITMAN ROAD
Practice Address - Street 2:SUITE LL 4
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747
Practice Address - Country:US
Practice Address - Phone:631-350-2719
Practice Address - Fax:631-350-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1235400599OtherSHAUN DIETERICH LMHC