Provider Demographics
NPI:1568146348
Name:LOGEMANN LLC
Entity Type:Organization
Organization Name:LOGEMANN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:515-423-4251
Mailing Address - Street 1:9612 ROSAS AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6606
Mailing Address - Country:US
Mailing Address - Phone:515-423-4251
Mailing Address - Fax:
Practice Address - Street 1:9910 INDIAN SCHOOL RD NE STE 201
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2957
Practice Address - Country:US
Practice Address - Phone:515-423-4251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)