Provider Demographics
NPI:1912648668
Name:MATHEWS, LOGAN PRESCOTT (LMFT, LPCC)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:PRESCOTT
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5430 PARADISE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HIDDEN HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-2434
Mailing Address - Country:US
Mailing Address - Phone:818-634-1390
Mailing Address - Fax:
Practice Address - Street 1:5430 PARADISE VALLEY RD
Practice Address - Street 2:
Practice Address - City:HIDDEN HILLS
Practice Address - State:CA
Practice Address - Zip Code:91302-2434
Practice Address - Country:US
Practice Address - Phone:818-634-1390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT119441106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LPCC7947OtherBOARD OF BEHAVIORAL SCIENCES
CALMFT119441OtherBOARD OF BEHAVIORAL SCIENCES