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NPI Code Detail

MEDICARE: AUBREY LOGAN LPC

MEDICARE: AUBREY LOGAN LPC
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
1101YM0800XMental Health Counselor18299AZ

General Provider Information

NPI Number : 1811530470
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUBREY LOGAN LPC
Provider Business Mailing Address
First Line : 3420 E SHEA BLVD STE 188
Second Line :
City : PHOENIX
State : AZ
Zip : 85028-3354
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3420 E SHEA BLVD STE 188
Second Line :
City : PHOENIX
State : AZ
Zip : 85028-3354
Country : US
Telephone Number : 602-529-6557
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2019
Last Update Date : 10/25/2019

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Directions to “ AUBREY LOGAN LPC” Practice Location

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