Provider Demographics
NPI:1003996307
Name:LOGAN, LANA YAEL (LCPC)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:YAEL
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16537 OAK PARK AVE.
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1752
Mailing Address - Country:US
Mailing Address - Phone:312-502-0118
Mailing Address - Fax:708-675-7574
Practice Address - Street 1:16537 OAK PARK AVE.
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1752
Practice Address - Country:US
Practice Address - Phone:312-502-0118
Practice Address - Fax:708-675-7574
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IL180007562101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker