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General NPI Number Information
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NPI Number | 1275049454
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Entity Type | Organization
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Legal Business Name | LOGAN & ASSOCIATES COUNSELING SESRVICES
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Dates
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Enumeration Date | 12/24/2017
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Last Update Date | 12/24/2017
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Provider Practice Location Address
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Address Line | 13161 W 143RD ST
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City | HOMER GLEN
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State | IL
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Zip | 60491-6890
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Country | US
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Telephone | 708-514-9422
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Fax | 815-230-1380
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Provider Business Mailing Address
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Address Line | 13161 W 143RD ST
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City | HOMER GLEN
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State | IL
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Zip | 60491-6890
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Country | US
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Telephone | 708-514-9422
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Fax | 815-230-1380
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Authorized Official
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Title or Position | PARTNER
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Name | MS. LANA YAEL LOGAN
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Credential | LCPC
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Telephone | 708-514-9422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 180007562
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License Number State | IL
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