Provider Demographics
NPI:1184909723
Name:LANDES, DEBRA MARY (LMHC)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:MARY
Last Name:LANDES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 NW 70TH ST APT 613
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2319
Mailing Address - Country:US
Mailing Address - Phone:561-389-3695
Mailing Address - Fax:
Practice Address - Street 1:1210 S FEDERAL HWY STE 201
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6044
Practice Address - Country:US
Practice Address - Phone:561-717-9920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4112101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health