Provider Demographics
NPI:1669464897
Name:LOGAN-BRUMMER, CAROL ANN (MA PLMHP, LMHC,CADC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:LOGAN-BRUMMER
Suffix:
Gender:F
Credentials:MA PLMHP, LMHC,CADC
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:BRUMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CADC
Mailing Address - Street 1:NORTH 6TH STREET AND AVENUE E
Mailing Address - Street 2:CHILDREN'S SQUARE USA
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51502-3008
Mailing Address - Country:US
Mailing Address - Phone:712-890-8597
Mailing Address - Fax:712-325-8200
Practice Address - Street 1:719 MILL STREET
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51502-3008
Practice Address - Country:US
Practice Address - Phone:712-890-8597
Practice Address - Fax:712-325-8200
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IACADC 035092101YA0400X
IA001129101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)