Provider Demographics
NPI:1558544635
Name:LOGAN, BRENDA RENEE (LMFT, CEAP)
Entity Type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:RENEE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LMFT, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 513283
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-1283
Mailing Address - Country:US
Mailing Address - Phone:323-791-8305
Mailing Address - Fax:
Practice Address - Street 1:1225 W 190TH ST
Practice Address - Street 2:SUITE 310
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4320
Practice Address - Country:US
Practice Address - Phone:323-753-7763
Practice Address - Fax:310-538-5518
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 45015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health