Provider Demographics
NPI:1477748473
Name:LOGAN, CASEY SUE (MED, LPCC)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:SUE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 HINKSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-9301
Mailing Address - Country:US
Mailing Address - Phone:606-209-1241
Mailing Address - Fax:
Practice Address - Street 1:1099 INDIAN MOUND DR STE A
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1652
Practice Address - Country:US
Practice Address - Phone:606-209-1241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY274046101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100855750Medicaid