Provider Demographics
NPI:1427583392
Name:VALENTINE, LOGAN KAY
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:KAY
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LOGAN
Other - Middle Name:KAY
Other - Last Name:VALENTINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:13 S 475 W
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-5607
Mailing Address - Country:US
Mailing Address - Phone:801-798-7700
Mailing Address - Fax:801-798-5476
Practice Address - Street 1:6612 S 3200 W
Practice Address - Street 2:
Practice Address - City:BENJAMIN
Practice Address - State:UT
Practice Address - Zip Code:84660-4123
Practice Address - Country:US
Practice Address - Phone:801-798-7700
Practice Address - Fax:801-798-5476
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT138242-3501101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor