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General NPI Number Information
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NPI Number | 1548513591
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Entity Type | Individual
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Provider Name | ALICIA LOGAN M.S, LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 10/16/2012
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 5000 LEGACY DR SUITE 400
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City | PLANO
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State | TX
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Zip | 75024-3100
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Country | US
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Telephone | 469-730-4055
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Fax | 469-453-6400
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Provider Business Mailing Address
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Address Line | 6627 GENSTAR LN
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City | DALLAS
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State | TX
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Zip | 75252-5444
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Country | US
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Telephone | 469-730-4055
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Fax | 469-453-6400
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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 | 67137
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 67137
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License Number State | TX
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