MEDICARE: LOGOS SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	65472	TX

General Provider Information

NPI Number	:	1215292081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOGOS SERVICES, LLC

Provider Business Mailing Address
First Line	:	5751 KROGER DR
Second Line	:	SUITE 269
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5632
Country	:	US
Telephone Number	:	817-812-2880
Fax Number	:

Provider Business Practice Location Address
First Line	:	5751 KROGER DR
Second Line	:	SUITE 269
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5632
Country	:	US
Telephone Number	:	817-812-2880
Fax Number	:

Authorized Official
Title or Position	:	LPC/OWNER
Name	:	MR. J. TODD BAKER
Credential	:	M.A., LPC-S, NCC
Telephone Number	:	817-812-2880

Provider Enumeration Date	:	07/09/2012
Last Update Date	:	07/09/2012

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