Provider Demographics
NPI:1104793124
Name:TIJERINA, LOGAN WHITE (MA, LPC)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:WHITE
Last Name:TIJERINA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 BELFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-4715
Mailing Address - Country:US
Mailing Address - Phone:337-427-8230
Mailing Address - Fax:337-270-9427
Practice Address - Street 1:1541 BELFIELD RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611-4715
Practice Address - Country:US
Practice Address - Phone:337-427-8230
Practice Address - Fax:337-270-9427
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8627101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional