Provider Demographics
NPI:1215400965
Name:LOGUE, ANTJE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANTJE
Middle Name:
Last Name:LOGUE
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 1:14678 MARIN HOLW
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-3918
Mailing Address - Country:US
Mailing Address - Phone:210-478-2417
Mailing Address - Fax:
Practice Address - Street 1:14743 OLD BANDERA RD UNIT 14-101
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-3733
Practice Address - Country:US
Practice Address - Phone:210-478-2417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-05
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71579101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional