Healthcare Provider Details

I. General information

NPI: 1386412054
Provider Name (Legal Business Name): LOGAN TERRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13195 SW 134TH ST STE 201
MIAMI FL
33186-4585
US

IV. Provider business mailing address

4175 NW 114TH AVE
CORAL SPRINGS FL
33065-7103
US

V. Phone/Fax

Practice location:
  • Phone: 561-421-5111
  • Fax:
Mailing address:
  • Phone: 561-664-5693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: