Provider Demographics
NPI:1245939107
Name:NUTTER, LOGAN CHAYSE
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:CHAYSE
Last Name:NUTTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 RAMBLING LN
Mailing Address - Street 2:
Mailing Address - City:BLUFF CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37618-4635
Mailing Address - Country:US
Mailing Address - Phone:276-780-5438
Mailing Address - Fax:
Practice Address - Street 1:352 RAMBLING LN
Practice Address - Street 2:
Practice Address - City:BLUFF CITY
Practice Address - State:TN
Practice Address - Zip Code:37618-4635
Practice Address - Country:US
Practice Address - Phone:276-780-5438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician