Provider Demographics
NPI:1366978835
Name:STINSON, LOGAN RAY
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:RAY
Last Name:STINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 W SHAWNEE ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-1028
Mailing Address - Country:US
Mailing Address - Phone:918-687-1039
Mailing Address - Fax:918-683-9484
Practice Address - Street 1:6220 W SHAWNEE ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-1028
Practice Address - Country:US
Practice Address - Phone:918-687-1039
Practice Address - Fax:918-683-9484
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor