Provider Demographics
NPI:1437992468
Name:LOGIE, KEVIN (AMFT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:LOGIE
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5247
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91616-5247
Mailing Address - Country:US
Mailing Address - Phone:716-725-5775
Mailing Address - Fax:
Practice Address - Street 1:11911 HART ST APT 2
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-5770
Practice Address - Country:US
Practice Address - Phone:716-725-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145953106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist