Provider Demographics
NPI:1043945793
Name:LOGAN, ANGEL MONIQUE (LPC)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:MONIQUE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4829 SALMON RUN WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-5654
Mailing Address - Country:US
Mailing Address - Phone:985-201-0375
Mailing Address - Fax:
Practice Address - Street 1:4829 SALMON RUN WAY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-5654
Practice Address - Country:US
Practice Address - Phone:985-201-0375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76282101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional