Healthcare Provider Details

I. General information

NPI: 1871086280
Provider Name (Legal Business Name): LOGAN BROOKE CARNES LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 KY 225
BARBOURVILLE KY
40906
US

IV. Provider business mailing address

PO BOX 1479
BARBOURVILLE KY
40906-5479
US

V. Phone/Fax

Practice location:
  • Phone: 859-209-2340
  • Fax: 606-545-9555
Mailing address:
  • Phone: 859-209-2340
  • Fax: 606-545-9555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number243367
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: