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Organization
QUALITY MENTAL HEALTH
Active
Organization
QUALITY MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOB LOGAN LPC (OWNER/LICENSED PROFESSIONAL COUNSEL)
(307) 426-4798
Entity
Organization
Contact information
Practice address
4025 RAWLINS ST, CHEYENNE, WY 82001-1900
(307) 426-4798
(307) 426-4799
Mailing address
4025 RAWLINS ST, CHEYENNE, WY 82001-1900
(307) 426-4798
(307) 426-4799
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-455
WY
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
LPC-455
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16662500
—
WY
01
—
310021
BCBS OF WYOMING
WY
Enumeration date
02/14/2013
Last updated
02/14/2013
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