Provider Demographics
NPI:1740330943
Name:PSYCHOLOGICAL ASSOCIATES OF LOGAN
Entity type:Organization
Organization Name:PSYCHOLOGICAL ASSOCIATES OF LOGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DINGESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-752-7707
Mailing Address - Street 1:306 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3906
Mailing Address - Country:US
Mailing Address - Phone:304-752-7707
Mailing Address - Fax:
Practice Address - Street 1:306 MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3906
Practice Address - Country:US
Practice Address - Phone:304-752-7707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty