MEDICARE: CATHERINE NICOLE LOGSDON MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	42020	CA

General Provider Information

NPI Number	:	1427116359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE NICOLE LOGSDON MFT

Provider Business Mailing Address
First Line	:	2071 ANTIOCH CT
Second Line	:	SUITE 201C
City	:	OAKLAND
State	:	CA
Zip	:	94611-2955
Country	:	US
Telephone Number	:	510-654-7695
Fax Number	:

Provider Business Practice Location Address
First Line	:	2071 ANTIOCH CT
Second Line	:	SUITE 201C
City	:	OAKLAND
State	:	CA
Zip	:	94611-2955
Country	:	US
Telephone Number	:	510-654-7695
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	12/30/2021

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