Provider Demographics
NPI:1295703924
Name:LOGAN, JOAN (CNS LPC)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:
Last Name:LOGAN
Suffix:
Gender:F
Credentials:CNS LPC
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6040 W 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-2905
Mailing Address - Country:US
Mailing Address - Phone:877-838-4783
Mailing Address - Fax:877-345-3501
Practice Address - Street 1:515 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7045
Practice Address - Country:US
Practice Address - Phone:719-471-2932
Practice Address - Fax:719-471-2932
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO234101YP2500X
CO65018163W00000X
CO364SP0813X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Geropsychiatric
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79652336Medicaid
COC71906Medicare PIN