Shannon Logan, LAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

37AC00293400 Issued in NJ

Practice address

1050 Wall St W Ste 310
Lyndhurst, NJ 07071-3615

Phone

(732) 982-2888

Fax

(847) 859-5885

NPI assigned

May 30, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• New Jersey Behavioral Health P.C

  • Psychologist
  • Princeton Junction, NJ
  • NPI 1538744297
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559174400000",
    "number": "1508424060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 E HAWTHORN PKWY STE 235",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600611454",
            "telephone_number": "847-737-8768",
            "fax_number": "847-859-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 WALL ST W STE 310",
            "city": "LYNDHURST",
            "state": "NJ",
            "postal_code": "070713615",
            "telephone_number": "732-982-2888",
            "fax_number": "847-859-5885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "SHANNON",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-30",
        "last_updated": "2019-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NJ",
            "license": "37AC00293400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Kelly Lew, PT, DPT
• Nicole Marie Liloia, LCSW
• Evgeniya Liminik, APN
• Antoine Lin, MPT, CSCS
• Rebecca Linares
• Matthew Lopes
• Roland Jerzy Losos, MD
• Lyndhurst Audiology Associates. LLC
• Lyndhurst Board of Education
• Lyndhurst Dental Medicine, LLC

• Mental Health Counselor in Lyndhurst, NJ
• Providers in Lyndhurst, NJ by specialty
• Mental Health Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.