Provider Demographics
NPI:1740344811
Name:LOGAN, MARIE F (LCPC)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:F
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 5TH ST SW
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-4901
Mailing Address - Country:US
Mailing Address - Phone:406-433-4635
Mailing Address - Fax:406-433-8201
Practice Address - Street 1:221 5TH ST SW
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-4901
Practice Address - Country:US
Practice Address - Phone:406-433-4635
Practice Address - Fax:406-433-8201
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT572101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000255527Medicaid