Provider Demographics
NPI:1831730910
Name:LOGAN, CHRISTOPHER PAUL (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:LOGAN
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10588 STONE CANYON RD APT 309
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-4419
Mailing Address - Country:US
Mailing Address - Phone:214-451-8996
Mailing Address - Fax:
Practice Address - Street 1:10588 STONE CANYON RD APT 309
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-4419
Practice Address - Country:US
Practice Address - Phone:214-451-8996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14179101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)