Provider Demographics
NPI:1952688038
Name:LOGOS COUNSELING CENTER
Entity Type:Organization
Organization Name:LOGOS COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BIENVENIDO
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:VALENTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD - PHD
Authorized Official - Phone:407-715-6062
Mailing Address - Street 1:1975 S JOHN YOUNG PKWY
Mailing Address - Street 2:SUITE 101 A
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-0603
Mailing Address - Country:US
Mailing Address - Phone:407-715-6062
Mailing Address - Fax:
Practice Address - Street 1:1975 S JOHN YOUNG PKWY
Practice Address - Street 2:SUITE 101 A
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-0603
Practice Address - Country:US
Practice Address - Phone:407-715-6062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBTR-04876261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center