Provider Demographics
NPI:1114700093
Name:LOGBACK, VICTORIA (LPC-A)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:LOGBACK
Suffix:
Gender:
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10330 LAKE RD STE Z
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1886
Mailing Address - Country:US
Mailing Address - Phone:346-478-5722
Mailing Address - Fax:
Practice Address - Street 1:10330 LAKE RD STE Z
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1886
Practice Address - Country:US
Practice Address - Phone:346-478-5722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92534101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health