MEDICARE: MENDY LOGAN LPC

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	101YP2500X	Professional Counselor	03890	KS
2	101YP2500X	Professional Counselor	03702-T	KS

General Provider Information

NPI Number	:	1891393179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MENDY LOGAN LPC

Provider Business Mailing Address
First Line	:	5838 W 21ST ST N STE 100
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67205-1795
Country	:	US
Telephone Number	:	316-202-9073
Fax Number	:

Provider Business Practice Location Address
First Line	:	5838 W 21ST ST N STE 100
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67205-1795
Country	:	US
Telephone Number	:	316-202-9073
Fax Number	:

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

Provider Enumeration Date	:	10/09/2020
Last Update Date	:	10/05/2022

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Directions to “ MENDY LOGAN LPC” Practice Location

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