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TENDERLY REAY LOGAN PPSC; LEP; APCC
School >> Psychologist >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1972273787
Individual Registrant: TENDERLY REAY LOGAN PPSC; LEP; APCC
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
675 CLOVER VALLEY RD UPPER LAKE, CA 95485-9220 US
Tel: 707-275-2338 Fax: --
Tel: 707-275-2338 Fax: --
Contact information for business:
675 CLOVER VALLEY RD UPPER LAKE, CA 95485-9220 US
Tel: 707-275-2338 Fax: --
Tel: 707-275-2338 Fax: --
Registration Information:
NPI: 1972273787
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 103TS0200X | Behavioral Health & Social Service Providers Psychologist School | CA | 3183 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
