Provider Demographics
NPI:1376033985
Name:LOGIC PSYCHOLOGY LLC
Entity Type:Organization
Organization Name:LOGIC PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HENKE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:314-346-8691
Mailing Address - Street 1:721 CHIPPENDALE CT
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5705
Mailing Address - Country:US
Mailing Address - Phone:314-346-8691
Mailing Address - Fax:
Practice Address - Street 1:8008 CARONDELET AVE STE 308
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1724
Practice Address - Country:US
Practice Address - Phone:314-346-8691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)