Provider Demographics
NPI:1558601443
Name:RIES, LOGAN A (LMFT)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:A
Last Name:RIES
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 1:407 6TH AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-5468
Mailing Address - Country:US
Mailing Address - Phone:732-547-8336
Mailing Address - Fax:
Practice Address - Street 1:108 MAIN ST STE 7
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1030
Practice Address - Country:US
Practice Address - Phone:732-547-8336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00173300106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist