Provider Demographics
NPI:1417527920
Name:LOGAN COOK COUNSELING, PLLC
Entity Type:Organization
Organization Name:LOGAN COOK COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-552-7385
Mailing Address - Street 1:127 N HIGGINS AVE STE 307D
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4486
Mailing Address - Country:US
Mailing Address - Phone:406-552-7385
Mailing Address - Fax:
Practice Address - Street 1:127 N HIGGINS AVE STE 307D
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4486
Practice Address - Country:US
Practice Address - Phone:406-552-7385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty