Provider Demographics
NPI:1689021982
Name:LOGAN, CHRISTINE (LMFT40238)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LMFT40238
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 N SUNRISE WAY
Mailing Address - Street 2:UNIT 1
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-5333
Mailing Address - Country:US
Mailing Address - Phone:818-618-3274
Mailing Address - Fax:
Practice Address - Street 1:1405 N SUNRISE WAY
Practice Address - Street 2:UNIT 1
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5333
Practice Address - Country:US
Practice Address - Phone:818-618-3274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT40238106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist