Provider Demographics
NPI:1902316326
Name:LANDA, TAYLER MICHELE (LCSW)
Entity Type:Individual
Prefix:
First Name:TAYLER
Middle Name:MICHELE
Last Name:LANDA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3149 OAKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-7106
Mailing Address - Country:US
Mailing Address - Phone:775-397-4559
Mailing Address - Fax:
Practice Address - Street 1:3740 LAKESIDE DR STE 202
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4952
Practice Address - Country:US
Practice Address - Phone:775-397-4559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7408-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical