Healthcare Provider Details

I. General information

NPI: 1699794826
Provider Name (Legal Business Name): LOG CABIN PSYCHOTHERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7217 ELY LAKE DR
EVELETH MN
55734-4007
US

IV. Provider business mailing address

3920 13TH AVE E SUITE 6
HIBBING MN
55746-3675
US

V. Phone/Fax

Practice location:
  • Phone: 218-744-0284
  • Fax: 218-744-2446
Mailing address:
  • Phone: 218-263-7540
  • Fax: 866-732-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8214
License Number StateMN

VIII. Authorized Official

Name: CATHERINE E ANDERSON
Title or Position: OWNER
Credential: MS, LICSW
Phone: 218-744-0284