Provider Demographics
NPI:1831492453
Name:LOGAN COMMUNITY SERVICES
Entity Type:Organization
Organization Name:LOGAN COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FSP-FAMILY SUPPORT PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRYE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-282-5524
Mailing Address - Street 1:4710 S. DIVISION STREET
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-6506
Mailing Address - Country:US
Mailing Address - Phone:405-282-5524
Mailing Address - Fax:405-282-4652
Practice Address - Street 1:4710 S. DIVISION STREET
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-6506
Practice Address - Country:US
Practice Address - Phone:405-282-5524
Practice Address - Fax:405-282-4652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22322251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management