Active NPI
Stephan Logan
- Counselor
- Clovis, NM
National Provider Identifier
1962736553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 121 Townsgate PLZ
Clovis, NM 88101-3714 - Phone
- (575) 742-2620
- NPI assigned
- Sep 29, 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
121 Townsgate PLZ
Clovis, NM 88101-3714
Mailing address
PO Box 28220
Santa Fe, NM 87592-8220
Phone (505) 471-5006
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254182400000",
"number": "1962736553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 28220",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875928220",
"telephone_number": "505-471-5006",
"fax_number": "505-820-9220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "121 TOWNSGATE PLZ",
"city": "CLOVIS",
"state": "NM",
"postal_code": "881013714",
"telephone_number": "575-742-2620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOGAN",
"first_name": "STEPHAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-09-29",
"last_updated": "2009-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clovis, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.