Provider Demographics
NPI:1932494614
Name:LOGAN, SHEILAH KELLEY (LMHC)
Entity Type:Individual
Prefix:
First Name:SHEILAH
Middle Name:KELLEY
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BERKELEY ST
Mailing Address - Street 2:D-146
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-2238
Mailing Address - Country:US
Mailing Address - Phone:321-537-4078
Mailing Address - Fax:321-777-1841
Practice Address - Street 1:50 BERKELEY ST
Practice Address - Street 2:D-146
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-2238
Practice Address - Country:US
Practice Address - Phone:321-537-4078
Practice Address - Fax:321-777-1841
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health