Basic Information
| Provider Information | |||||||||
| NPI: | 1083275721 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAND | ||||||||
| FirstName: | RECA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7212 HATTON RD | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791104329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8066407646 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4104 SW 33RD AVE | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791091203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8068039671 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2019 | ||||||||
| LastUpdateDate: | 06/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 67648 | TX | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.