Provider Demographics
NPI:1720703770
Name:LANDRY, GRACE DENISE (LPC)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:DENISE
Last Name:LANDRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 DOVERGLEN DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-4214
Mailing Address - Country:US
Mailing Address - Phone:281-703-5922
Mailing Address - Fax:
Practice Address - Street 1:2515 DOVERGLEN DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-4214
Practice Address - Country:US
Practice Address - Phone:281-703-5922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84307101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional