Provider Demographics
NPI:1477135747
Name:WINDER, LOGAN DANIEL (IMFT)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:DANIEL
Last Name:WINDER
Suffix:
Gender:M
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 S 700 W
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-1206
Mailing Address - Country:US
Mailing Address - Phone:435-668-2258
Mailing Address - Fax:
Practice Address - Street 1:1079 E RIVERSIDE DR STE 203
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4735
Practice Address - Country:US
Practice Address - Phone:435-414-8658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist