Organization
MOUNT LOGAN CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE HANCOCK PHD (OWNER/PROVIDER)
(435) 750-6300
Entity
Organization
Contact information
Practice address
246 E 1260 N, LOGAN, UT 84341-7501
(435) 750-6300
(435) 753-8995
Mailing address
246 E 1260 N, LOGAN, UT 84341-7501
(435) 750-6300
(435) 753-8995
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
04/13/2020
Last updated
07/29/2021
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