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Organization

LANDRY COUNSELING AND SUPERVISION SERVICES, PLLC

Active
Other names
OpenGate
Organization subpart
No

Provider details

NPI number
Authorized official
KATHLEEN MARIE LANDRY MA, LCMHC (OWNER/ CLINICAL DIRECTOR)
(802) 793-9850
Entity
Organization

Contact information

Practice address
760 KENT HILL RD, EAST CALAIS, VT 05650-8048
(802) 793-9850
Mailing address
760 KENT HILL RD, EAST CALAIS, VT 05650-8048
(802) 793-9850

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1021075
VERMONT MEDICAID PROVIDER ID
VT
01
12443277
CAQH CLEARINGHOUSE
01
3019214
MVP PROVIDER ID
VT
Enumeration date
07/25/2024
Last updated
07/25/2024
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