Provider Demographics
NPI:1235920182
Name:LANDRY, JEREMY (LPC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:LANDRY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 ROAD 66121
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-1366
Mailing Address - Country:US
Mailing Address - Phone:713-775-8475
Mailing Address - Fax:
Practice Address - Street 1:95 ROAD 66121
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-1366
Practice Address - Country:US
Practice Address - Phone:713-775-8475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74370101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional