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Patricia Logan

Psychologist

Behavioral Health & Social Service Providers

PECOS Enrollment

Based on the most recent information from CMS, provider Patricia Logan is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1083922603
Provider Type
Individual
Full Name
Logan, Patricia
Credential
PH.D

Gender
Female
Sole Proprietor
No
Enumeration Date
9/16/2010
Last Updated
12/23/2015

Contact Information

Practice Location

2500 N State St, Jackson, MS 39216-4500

(601) 984-5863

Unlisted Fax

Mailing Location

2500 N State St, Jackson, MS 39216-4500

(601) 984-5863

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 103TC0700X Primary	Description Psychologist Behavioral Health & Social Service Providers	License T55974 Mississippi
Code 103TC0700X	Description Psychologist Behavioral Health & Social Service Providers	License 6715 Ohio

Patricia Logan

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Seifen, Tanja

Dubbert, Patricia Marie

Lott, William C

Johnson, Phillip

Hermes, Susan F

Sutton, Monica J

Schumacher-Coffey, Julie A

Foster, Penni Smith

Schmidt, Nicholas

Young, Lashun A.