Provider Demographics
NPI:1063797785
Name:LOGAN, MALINDA P (LCSW)
Entity type:Individual
Prefix:MS
First Name:MALINDA
Middle Name:P
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19735 LOGAN BRIAR DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-1786
Mailing Address - Country:US
Mailing Address - Phone:979-388-8530
Mailing Address - Fax:
Practice Address - Street 1:3845 FM 1960 RD W STE 350
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3567
Practice Address - Country:US
Practice Address - Phone:979-388-8530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX637131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical