Healthcare Provider Details

I. General information

NPI: 1104584200
Provider Name (Legal Business Name): LOGAN N HUBBARD LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3556 S 5600 W # 557
SALT LAKE CITY UT
84120-2815
US

IV. Provider business mailing address

3556 S 5600 W # 557
SALT LAKE CITY UT
84120-2815
US

V. Phone/Fax

Practice location:
  • Phone: 615-669-0089
  • Fax:
Mailing address:
  • Phone: 615-669-0089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1853
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number14269230-3902
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: