Individual
TARA LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LLPC, LLMFT
Contact information
Practice address
157 S KALAMAZOO MALL STE 250, KALAMAZOO, MI 49007-4828
(269) 422-0565
Mailing address
1533 N PARK ST, KALAMAZOO, MI 49007-1806
(269) 422-0565
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
6401018406
MI
106H00000X
Marriage & Family Therapist
Primary
4151000532
MI
Other
Enumeration date
07/15/2020
Last updated
07/15/2020
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