Provider Demographics
NPI:1457466831
Name:LOGAN, JEAN WILSON (LMFT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:WILSON
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 W ALABAMA ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-1722
Mailing Address - Country:US
Mailing Address - Phone:713-960-8949
Mailing Address - Fax:
Practice Address - Street 1:3355 W ALABAMA ST
Practice Address - Street 2:SUITE180
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-1722
Practice Address - Country:US
Practice Address - Phone:713-960-8949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004140106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist