Provider Demographics
NPI:1730180647
Name:WINFREY, LAPEARL LOGAN (PHD)
Entity type:Individual
Prefix:
First Name:LAPEARL
Middle Name:LOGAN
Last Name:WINFREY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 341648
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45434-1648
Mailing Address - Country:US
Mailing Address - Phone:937-254-9210
Mailing Address - Fax:937-254-9267
Practice Address - Street 1:1255 N FAIRFIELD RD STE 201
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2651
Practice Address - Country:US
Practice Address - Phone:937-254-9210
Practice Address - Fax:937-254-9267
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5852103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical