Provider Demographics
NPI:1851047385
Name:LOGAN PROFESSIONAL COUNSELING SERVICES
Entity Type:Organization
Organization Name:LOGAN PROFESSIONAL COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADE
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:304-688-9269
Mailing Address - Street 1:710 STRATTON ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-4015
Mailing Address - Country:US
Mailing Address - Phone:304-688-9269
Mailing Address - Fax:681-495-1522
Practice Address - Street 1:101 DINGESS ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3603
Practice Address - Country:US
Practice Address - Phone:304-688-9269
Practice Address - Fax:681-495-1522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)