Active NPI
Gayle Vence Logan, MA,LMSW,LPC
- Professional Counselor
- Philadelphia, PA
National Provider Identifier
1821377854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- PC005429
- Practice address
- 2449 Golf Rd Ste 14
Philadelphia, PA 19131-1475 - Phone
- (215) 477-3103
- Fax
- (215) 477-3104
- NPI assigned
- Aug 9, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 | PC005429 | PA | Primary |
Addresses
Primary practice location
2449 Golf Rd Ste 14
Philadelphia, PA 19131-1475
Mailing address
2449 Golf Rd Ste 14
Philadelphia, PA 19131-1475
Phone (215) 477-3103
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1800 JFK Blvd
Suite 1404
Philadelphia, PA 19103-7417
Phone (855) 284-7483
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thrive Counseling LLC | Current | Accepting new patients |
Locations
5830 Ellsworth Ave
Ste 301
Pittsburgh, PA 15232
Phone (412) 208-6279
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312848000000",
"number": "1821377854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2449 GOLF RD STE 14",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191311475",
"telephone_number": "215-477-3103",
"fax_number": "215-477-3104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2449 GOLF RD STE 14",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191311475",
"telephone_number": "215-477-3103",
"fax_number": "215-477-3104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOGAN",
"first_name": "GAYLE",
"middle_name": "VENCE",
"name_prefix": "Ms.",
"credential": "MA,LMSW,LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-08-09",
"last_updated": "2011-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "PA",
"license": "PC005429",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2011; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.