MEDICARE: LOGAN WALTERS MS., LMHC., NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH17776	FL

General Provider Information

NPI Number	:	1154955581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOGAN WALTERS MS., LMHC., NCC

Provider Business Mailing Address
First Line	:	8588 STARKEY RD
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33777-2831
Country	:	US
Telephone Number	:	828-734-4877
Fax Number	:

Provider Business Practice Location Address
First Line	:	8588 STARKEY RD
Second Line	:
City	:	SEMINOLE
State	:	FL
Zip	:	33777-2831
Country	:	US
Telephone Number	:	828-734-4877
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2020
Last Update Date	:	02/25/2020

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