Provider Demographics
NPI:1043844558
Name:DICKESON, LANDON CHANDLER (LPC)
Entity type:Individual
Prefix:
First Name:LANDON
Middle Name:CHANDLER
Last Name:DICKESON
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 1:9477 FORT WORTH DR
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-9371
Mailing Address - Country:US
Mailing Address - Phone:214-830-8998
Mailing Address - Fax:800-972-3802
Practice Address - Street 1:9477 FORT WORTH DR
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:TX
Practice Address - Zip Code:76226-9371
Practice Address - Country:US
Practice Address - Phone:214-830-8998
Practice Address - Fax:800-972-3802
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79249101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXLDRHR06OtherYBM ID