Provider Demographics
NPI:1386306371
Name:LANSDALE, EMILY DALENDA
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:DALENDA
Last Name:LANSDALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 BELLE RIVA DR
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650-6133
Mailing Address - Country:US
Mailing Address - Phone:903-932-3278
Mailing Address - Fax:
Practice Address - Street 1:127 BELLE RIVA DR
Practice Address - Street 2:
Practice Address - City:HALLSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75650-6133
Practice Address - Country:US
Practice Address - Phone:903-932-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health