Provider Demographics
NPI:1891393179
Name:LOGAN, MENDY (LPC)
Entity Type:Individual
Prefix:
First Name:MENDY
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5838 W 21ST ST N STE 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1795
Mailing Address - Country:US
Mailing Address - Phone:316-202-9073
Mailing Address - Fax:
Practice Address - Street 1:5838 W 21ST ST N STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1795
Practice Address - Country:US
Practice Address - Phone:316-202-9073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03890101YP2500X
KS03702-T101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional