Active NPI
Jennifer D Logan, LPC
- Professional Counselor
- Austell, GA
National Provider Identifier
1700560406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 014008
- Practice address
- 6133 Love St
Austell, GA 30168-4711 - Phone
- (678) 718-5618
- NPI assigned
- Jun 13, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 014008 | GA | Primary |
Addresses
Primary practice location
6133 Love St
Austell, GA 30168-4711
Mailing address
PO Box 670121
Marietta, GA 30066-0119
Phone (770) 851-8043
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 014008 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686614400000",
"number": "1700560406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 670121",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300660119",
"telephone_number": "770-851-8043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6133 LOVE ST",
"city": "AUSTELL",
"state": "GA",
"postal_code": "301684711",
"telephone_number": "678-718-5618"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOGAN",
"first_name": "JENNIFER",
"middle_name": "D",
"name_prefix": "Ms.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-13",
"last_updated": "2023-06-13",
"certification_date": "2023-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "014008",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.