Provider Demographics
NPI:1407004971
Name:NANCY A LOGAN, PHD. PC
Entity Type:Organization
Organization Name:NANCY A LOGAN, PHD. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HILDEBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-615-0555
Mailing Address - Street 1:24123 BOERNE STAGE RD
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-9403
Mailing Address - Country:US
Mailing Address - Phone:210-615-0555
Mailing Address - Fax:210-687-1100
Practice Address - Street 1:24123 BOERNE STAGE RD
Practice Address - Street 2:SUITE 430
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78255-9403
Practice Address - Country:US
Practice Address - Phone:210-615-0555
Practice Address - Fax:210-687-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23696103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00G66COtherBLUE CROSS BLUE SHIELD
TX00G66COtherBLUE CROSS BLUE SHIELD