| Debra Logan Lcsw Llc | |
|
101 S Main St Ste D Cottonwood AZ 86326-6979 | |
| (928) 202-9054 | |
| Not Available |
| Full Name | Debra Logan Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 101 S Main St Ste D, Cottonwood, Arizona |
| Authorized Official Name and Position | Debra Logan (PROVIDER) |
| Authorized Official Contact | 9282029054 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Debra Logan Lcsw Llc 1895 W Desert Willow Dr Cottonwood AZ 86326-8304 Ph: () - | Debra Logan Lcsw Llc 101 S Main St Ste D Cottonwood AZ 86326-6979 Ph: (928) 202-9054 |
| NPI Number | 1184164618 |
|---|---|
| Provider Enumeration Date | 03/02/2017 |
| Last Update Date | 07/06/2023 |
| Certification Date | 07/06/2023 |
| Medicare PECOS PAC ID | 9335416619 |
|---|---|
| Medicare Enrollment ID | O20170517002618 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184164618 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 10464 (Arizona) | Primary |
| Provider Name | Debra L Logan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134126816 PECOS PAC ID: 8527020031 Enrollment ID: I20090924000703 |
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