Provider Demographics
NPI:1033429899
Name:LAMPRECHT, LOGAN MARSH (PHD, LCPC, M COUN)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:MARSH
Last Name:LAMPRECHT
Suffix:
Gender:M
Credentials:PHD, LCPC, M COUN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 E RIVERSIDE DR # 120533E
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6095
Mailing Address - Country:US
Mailing Address - Phone:208-339-1279
Mailing Address - Fax:
Practice Address - Street 1:533 E RIVERSIDE DR # 120533E
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6095
Practice Address - Country:US
Practice Address - Phone:208-339-1279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC6784101Y00000X
IDNCC-225208101YM0800X
OHC.0700919101YM0800X
ID6784101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional