MEDICARE: LOGAN MOUNT

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	017075	NY

General Provider Information

NPI Number	:	1689523649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOGAN MOUNT

Provider Business Mailing Address
First Line	:	6 MORNINGSIDE DR
Second Line	:
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019-1530
Country	:	US
Telephone Number	:	518-423-1590
Fax Number	:	518-423-1590

Provider Business Practice Location Address
First Line	:	6 MORNINGSIDE DR
Second Line	:
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019-1530
Country	:	US
Telephone Number	:	518-423-1590
Fax Number	:	518-423-1590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2026
Last Update Date	:	03/11/2026

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Directions to “ LOGAN MOUNT ” Practice Location

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