Provider Demographics
NPI:1821720574
Name:MONTGOMERY, LOGAN MARSHALL (MA, LMHCA)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:MARSHALL
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 N STATE HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-7189
Mailing Address - Country:US
Mailing Address - Phone:812-346-7744
Mailing Address - Fax:
Practice Address - Street 1:2990 N STATE HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-7189
Practice Address - Country:US
Practice Address - Phone:812-346-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88001618A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health