Healthcare Provider Details

I. General information

NPI: 1336924075
Provider Name (Legal Business Name): AMY LOGAN LMHC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 WATKINS LN UNIT 3-201
NAPERVILLE IL
60540-7253
US

IV. Provider business mailing address

1511 WATKINS LN UNIT 3-201
NAPERVILLE IL
60540-7253
US

V. Phone/Fax

Practice location:
  • Phone: 858-776-1965
  • Fax:
Mailing address:
  • Phone: 858-776-1965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39004655A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: