Provider Demographics
NPI:1578737193
Name:DR RICHARD B GARVER & DR NANCY A LOGAN, PC
Entity Type:Organization
Organization Name:DR RICHARD B GARVER & DR NANCY A LOGAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/GENERAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-615-0555
Mailing Address - Street 1:24123 BOERNE STAGE RD STE 430
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-9409
Mailing Address - Country:US
Mailing Address - Phone:210-615-0555
Mailing Address - Fax:210-687-1100
Practice Address - Street 1:24123 BOERNE STAGE RD STE 430
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78255-9409
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:2008-04-15
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23696103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000668XMedicare PIN