Provider Demographics
NPI:1598521593
Name:LOGAR, BRIAN KEITH JR
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:LOGAR
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 WELLNESS DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-5401
Mailing Address - Country:US
Mailing Address - Phone:304-872-0058
Mailing Address - Fax:304-872-0116
Practice Address - Street 1:180 WELLNESS DR
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-5401
Practice Address - Country:US
Practice Address - Phone:304-872-0058
Practice Address - Fax:304-872-0116
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician