Provider Demographics
NPI:1518010958
Name:LOGSTON, BRANDY JANE (MA AND PLMHP)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:JANE
Last Name:LOGSTON
Suffix:
Gender:F
Credentials:MA AND PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72392 611 AVE
Mailing Address - Street 2:
Mailing Address - City:CRAB ORCHARD
Mailing Address - State:NE
Mailing Address - Zip Code:68332-5111
Mailing Address - Country:US
Mailing Address - Phone:402-876-5421
Mailing Address - Fax:
Practice Address - Street 1:722 COURT ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-3926
Practice Address - Country:US
Practice Address - Phone:402-223-3843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health