Individual
MS. ALBERTA GAEA LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1244 PINE ST, BOULDER, CO 80302-4809
(512) 694-1393
Mailing address
7322 YUCCA CT, BOULDER, CO 80301-3932
(512) 694-1393
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0013418
CO
101YP2500X
Professional Counselor
Primary
0013418
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0013418
LPC LICENSE
CO
Enumeration date
02/08/2019
Last updated
06/11/2019
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