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General NPI Number Information
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NPI Number | 1871086280
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Entity Type | Individual
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Provider Name | LOGAN BROOKE CARNES LPCA
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Gender | Female
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 08/01/2018
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Provider Practice Location Address
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Address Line | 415 KY 225
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City | BARBOURVILLE
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State | KY
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Zip | 40906
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Country | US
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Telephone | 859-209-2340
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Fax | 606-545-9555
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Provider Business Mailing Address
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Address Line | PO BOX 1479
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City | BARBOURVILLE
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State | KY
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Zip | 40906-5479
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Country | US
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Telephone | 859-209-2340
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Fax | 606-545-9555
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 243367
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License Number State | KY
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