Provider Demographics
NPI:1992187918
Name:YORK, LOGAN VICTORIA (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:VICTORIA
Last Name:YORK
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 FUJI LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-8800
Mailing Address - Country:US
Mailing Address - Phone:931-292-2601
Mailing Address - Fax:931-292-2601
Practice Address - Street 1:1024 FUJI LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-8800
Practice Address - Country:US
Practice Address - Phone:931-292-2601
Practice Address - Fax:931-292-2601
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
TN384103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst