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General NPI Number Information
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NPI Number | 1881426377
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Entity Type | Individual
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Provider Name | LOGAN BENNETT LCSW, LCDC
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Gender | Male
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Dates
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Enumeration Date | 08/14/2024
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 205 E MONROE ST
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City | AUSTIN
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State | TX
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Zip | 78704-2424
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Country | US
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Telephone | 512-791-3778
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Fax |
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Provider Business Mailing Address
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Address Line | 9604 PRESCOTT DR
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City | AUSTIN
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State | TX
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Zip | 78749-5203
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Country | US
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Telephone | 512-791-3778
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 106416
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License Number State | TX
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