Provider Demographics
NPI:1245586973
Name:JEFFRIES, LOGAN RAY
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:RAY
Last Name:JEFFRIES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-6312
Mailing Address - Country:US
Mailing Address - Phone:702-466-3829
Mailing Address - Fax:
Practice Address - Street 1:1831 STEVENS ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-6312
Practice Address - Country:US
Practice Address - Phone:702-493-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor