Individual
LOGAN LUSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 IMPERIAL BLVD STE E, HENDERSONVILLE, TN 37075-3400
(615) 560-6622
Mailing address
2308 RIVERCHASE BLVD, MADISON, TN 37115-2059
(901) 552-7916
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/19/2023
Last updated
07/19/2023
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