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General NPI Number Information
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NPI Number | 1649711797
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Entity Type | Individual
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Provider Name | LINDSEY LOGAN LPC
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Gender | Female
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 823 N JIM THORPE BLVD
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City | PRAGUE
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State | OK
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Zip | 74864-4522
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Country | US
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Telephone | 405-567-7059
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Fax |
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Provider Business Mailing Address
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Address Line | 100085 N 3620 RD
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City | PADEN
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State | OK
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Zip | 74860-7138
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Country | US
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Telephone |
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Fax |
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7375
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License Number State | OK
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