Active NPI
Logan M Pence, LICDC
- Addiction (Substance Use Disorder) Counselor
- Eaton, OH
National Provider Identifier
1104065564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 943841
- Practice address
- 228 N Barron St
Eaton, OH 45320-1704 - Phone
- (937) 456-7694
- Fax
- (937) 456-7753
- NPI assigned
- Feb 9, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 943841 | OH | Primary |
Addresses
Primary practice location
228 N Barron St
Eaton, OH 45320-1704
Mailing address
228 N Barron St
Eaton, OH 45320-1704
Phone (937) 456-7694
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 943841 | OH | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234137600000",
"number": "1104065564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "228 N BARRON ST",
"city": "EATON",
"state": "OH",
"postal_code": "453201704",
"telephone_number": "937-456-7694",
"fax_number": "937-456-7753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "228 N BARRON ST",
"city": "EATON",
"state": "OH",
"postal_code": "453201704",
"telephone_number": "937-456-7694",
"fax_number": "937-456-7753"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENCE",
"first_name": "LOGAN",
"middle_name": "M",
"credential": "LICDC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-02-09",
"last_updated": "2009-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "943841",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eaton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.