| NPI | 1912259912 |
|---|---|
| Former Name | LOGAN RENEE GILLEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TN 1116) |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2025-01-29 |