Provider Demographics
NPI:1639403652
Name:LOGAN, STEVEN (PHD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:LOGAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12325 WOODLANDS CIR
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-8284
Mailing Address - Country:US
Mailing Address - Phone:810-287-1003
Mailing Address - Fax:
Practice Address - Street 1:12325 WOODLAND CIRCLE
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525
Practice Address - Country:US
Practice Address - Phone:810-287-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health