Individual
MISS MARIAH LYN LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC,LCPC
Contact information
Practice address
11500 OLIVE BLVD STE 176, CREVE COEUR, MO 63141-7147
(618) 972-1568
(618) 205-3561
Mailing address
207 GLEN MEADOW RD, FRANKLIN, MA 02038-1341
(314) 541-4618
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
180.014691
IL
101YP2500X
Professional Counselor
Primary
2023048395
MO
Other
Enumeration date
04/01/2020
Last updated
03/15/2024
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