Provider Demographics
NPI:1184090847
Name:LOGAN HEALTH & HEALING CENTER, INC
Entity type:Organization
Organization Name:LOGAN HEALTH & HEALING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-316-2621
Mailing Address - Street 1:1740 S BELL SCHOOL RD STE B
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61016-9388
Mailing Address - Country:US
Mailing Address - Phone:815-316-2621
Mailing Address - Fax:800-493-9260
Practice Address - Street 1:1740 S BELL SCHOOL RD STE B
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61016-9388
Practice Address - Country:US
Practice Address - Phone:815-316-2621
Practice Address - Fax:800-493-9260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1184090847OtherLOGAN HEALTH AND HEALING CENTER INC