Provider Demographics
NPI:1265230718
Name:LOGAN, MELISSA S
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:LOGAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 LOYSTON RD
Mailing Address - Street 2:
Mailing Address - City:MAYNARDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37807-2200
Mailing Address - Country:US
Mailing Address - Phone:865-363-0211
Mailing Address - Fax:
Practice Address - Street 1:4335 MAYNARDVILLE HWY
Practice Address - Street 2:
Practice Address - City:MAYNARDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37807-3623
Practice Address - Country:US
Practice Address - Phone:865-992-3867
Practice Address - Fax:865-992-7238
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker