Provider Demographics
NPI:1598426546
Name:LOGSDON, SHELBY T (MMFT)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:T
Last Name:LOGSDON
Suffix:
Gender:F
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1764 ELMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-8861
Mailing Address - Country:US
Mailing Address - Phone:931-206-4807
Mailing Address - Fax:
Practice Address - Street 1:130 HILLCREST DR STE 207
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5083
Practice Address - Country:US
Practice Address - Phone:931-206-4807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist