# MOUNT LOGAN CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275152910
- **Authorized official:** KYLE HANCOCK PHD (OWNER/PROVIDER)
- **Authorized official phone:** (435) 750-6300

## Contact information

- **Practice address:** 246 E 1260 N, LOGAN, UT 84341-7501
- **Practice address phone:** (435) 750-6300
- **Practice address fax:** (435) 753-8995
- **Mailing address:** 246 E 1260 N, LOGAN, UT 84341-7501
- **Mailing address phone:** (435) 750-6300
- **Mailing address fax:** (435) 753-8995

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 04/13/2020
- **Last updated:** 07/29/2021