Provider Demographics
NPI:1679318133
Name:PEEVY, LOGAN (NCC, LAC)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:PEEVY
Suffix:
Gender:F
Credentials:NCC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7420 E CAMELBACK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3509
Mailing Address - Country:US
Mailing Address - Phone:480-256-2605
Mailing Address - Fax:
Practice Address - Street 1:7420 E CAMELBACK RD STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3509
Practice Address - Country:US
Practice Address - Phone:480-256-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-22701101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health