Provider Demographics
NPI:1477323665
Name:LOGAN, DELANEY (LMHC-T)
Entity Type:Individual
Prefix:
First Name:DELANEY
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LMHC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 28TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-3532
Mailing Address - Country:US
Mailing Address - Phone:319-929-4357
Mailing Address - Fax:
Practice Address - Street 1:3412 CENTER POINT RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5575
Practice Address - Country:US
Practice Address - Phone:319-382-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA124143101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health