Provider Demographics
NPI:1316155484
Name:LANDRY, ROBERT LAWRENCE JR (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LAWRENCE
Last Name:LANDRY
Suffix:JR
Gender:M
Credentials:PHD, LPC
Other - Prefix:DR
Other - First Name:BUDDY
Other - Middle Name:
Other - Last Name:LANDRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, LPC
Mailing Address - Street 1:2307 SANDALWOOD PL
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-7707
Mailing Address - Country:US
Mailing Address - Phone:228-497-1446
Mailing Address - Fax:
Practice Address - Street 1:2809 DENNY AVE
Practice Address - Street 2:SUITE 1005
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5301
Practice Address - Country:US
Practice Address - Phone:228-497-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0936101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional