| NPI | 1952595381 |
|---|---|
| Other Name | GARY LANDIS |
| Entity Type | Organization |
| Authorized Contact | GARY DANE LANDIS Owner/Therapist 270-299-2262 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: KY 0485) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: KY 0485) |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: KY 0485) | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: KY 0436) | |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2007-08-29 |