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General NPI Number Information
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NPI Number | 1245829530
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Entity Type | Individual
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Provider Name | AUSTIN ANDREW LOGAN LCPC
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Gender | Male
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 1250 15TH ST W STE 101 STE. 101
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City | BILLINGS
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State | MT
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Zip | 59102-4155
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Country | US
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Telephone | 406-247-4966
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Fax |
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Provider Business Mailing Address
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Address Line | 48 GRAND AVE
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City | BILLINGS
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State | MT
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Zip | 59101-6019
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Country | US
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Telephone | 406-679-1337
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Fax | 406-379-1337
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | BBH-LCPC-LIC-45395
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License Number State | MT
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