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General NPI Number Information
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NPI Number | 1669683520
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Entity Type | Individual
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Provider Name | TINA ANN LOGAN SR. MFT INTER
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 8220 S. SAN PEDRO STREET
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City | LOS ANGELES
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State | CA
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Zip | 90003
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Country | US
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Telephone | 323-789-5640
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Fax | 323-789-5648
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Provider Business Mailing Address
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Address Line | 1227 BARRY AVE APT 7
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City | LOS ANGELES
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State | CA
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Zip | 90025-1799
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Country | US
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Telephone | 310-575-9651
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 46136
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License Number State | CA
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