Provider Demographics
NPI:1619734159
Name:LOGAN, KATHERINE SWANSON (AMFT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SWANSON
Last Name:LOGAN
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:823 N RIDGEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-4327
Mailing Address - Country:US
Mailing Address - Phone:310-351-7982
Mailing Address - Fax:
Practice Address - Street 1:10700 SANTA MONICA BLVD STE 311
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6587
Practice Address - Country:US
Practice Address - Phone:310-843-9902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138521106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist