Provider Demographics
NPI:1245829530
Name:LOGAN, AUSTIN ANDREW (LCPC)
Entity type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:ANDREW
Last Name:LOGAN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-6019
Mailing Address - Country:US
Mailing Address - Phone:406-679-1337
Mailing Address - Fax:406-379-1337
Practice Address - Street 1:1250 15TH ST W STE 101
Practice Address - Street 2:STE. 101
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4155
Practice Address - Country:US
Practice Address - Phone:406-247-4966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-45395101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health