Provider Demographics
NPI:1023427986
Name:COHEN, LOGAN
Entity type:Individual
Prefix:MR
First Name:LOGAN
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3674 N RANCHO DR
Mailing Address - Street 2:101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3110
Mailing Address - Country:US
Mailing Address - Phone:702-776-8397
Mailing Address - Fax:
Practice Address - Street 1:3674 N RANCHO DR
Practice Address - Street 2:101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3110
Practice Address - Country:US
Practice Address - Phone:702-776-8397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst